Co-Opting Voluntarism? Exploring the Implications of Long-Term Care Reform for the Nonprofit Sector in Ontario

Within public policy discourse on health care restructuring and voluntarism, the nonprofit sector is now expected to play an active and direct role in the provision of health care services. The viability of the nonprofit sector to take up this role, however, remains unclear. This paper explores the changing role of nonprofit organisations with respect to the provision of long-term care in Ontario, Canada, where extensive restructuring of public services occurred during the 1990s. Drawing on a critical review of legislation, government policies and documents, and stakeholder reports, the authors present a comparative study of two distinct long-term care reform models, featuring public and private provision, respectively, which were developed by ideologically opposed provincial governments. The results indicate that despite unanimous promotion of voluntarism (and the attendant ascendancy of the nonprofit sector) as a central feature of health care restructuring, the divergent reform models actually trap nonprofit organisations between direct incorporation within public provision on the one hand, and direct free-market competition on the other. The findings suggest that underscoring long-term care reform in Ontario, and elsewhere, is the co-option of the nonprofit sector, which resonates with concern for its ability to replace effectively the public provision of health care services. The results also point to the need to conceptualise the consequent actions taken by nonprofit organisations in order to inform current debates surrounding health care restructuring and voluntarism.