Date of Award


Degree Type


Degree Name

Master of Science in Nursing




Dr. C. Ward-Griffin

Second Advisor

Dr. D. Forbes


The current homecare structure cannot sustain adequate care for seniors living at home even with the support of family caregivers (Forbes & Neufeld , 2008). Indeed, two thirds of community-dwelling seniors receive some form of care from their adult children/children-in-law. However, seniors living with dementia can have additional care needs. Siblings/siblings-in-law are often involved in the negotiation of homecare with their parents/parents-in-law living with dementia. Based on a larger critical ethnographie study of client-caregiver-provider relationships in home-based dementia care (WardGriffin, McWilliam, Forbes, Klosek, Mowatt, & Bol, 2008), the purpose of this qualitative secondary analysis was to examine the relationships of siblings/siblings-in- law in the negotiation of home-based dementia care. The findings revealed two overarching themes, the social determinants of care and the negotiation of care. There were three social determinants of care: gender, birth order and proximity. The negotiation of care was the continuous enactment of performance measurement and positional power, premised on a set of expectations and quantifiable benchmarks. The social determinants of care coupled with the negotiation of care shaped the health experiences of the siblings/siblings-in-law of this study. The health enhancing experiences were epitomized by family cohesion, while the health threatening experiences embodied conflict and inequities in the distribution of care. These findings have direct implications for homecare nursing practice, policy and future research, which could further recognize the complexity of sibling/sibling-in-law relationships in terms of care planning.



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