Table 3 Tensions presented in the survey

Returning older adults at home safely vs freeing up hospital beds

I should be insisting on lengths of stay that allow a safe return home for the older adults in my case load. However, I feel I am helping to empty the hospital beds as quickly as possible.

Respect the “complex” case management model and the “regular” case management model vs. promote stability for users¹

For “regular” case managers:

I should transfer my files that have become “complex” to the case managers dedicated to these files. However, I’m keeping my files because I think it’s better for older adults to have “stability”.

For “complex” case managers:

I should receive the “complex” files from “regular” case managers. However, although I believe that these files would require my intervention, I don’t insist on receiving them because I feel that this offers stability to older adults.

Using home care allocation documents in the prescribed manner vs. entering information in the documents to arrive at the allocation I deem necessary

I should complete the documents in the prescribed manner. However, to obtain the necessary services for older adults, I “manipulate” the information in the documents so that it matches the criteria leading to the allocation of needed home care services (e.g., the older adults in my caseload are all “poor”).

Respecting organisational rules and not being in a position to enable ageing in place vs. transgressing them to enable ageing in place

I should follow certain rules in my work. However, I sometimes break them (e.g., I go shopping with the older adult, I give them a ride in my car, I do things I shouldn’t do) to enable them to age in place.

Delegating care to “partners” vs managing the quality of services provided by partners

I should be working with my partners. However, I feel that my work with them is mainly aimed at controlling the quality of the services they provide and “putting out the fires” they cause.

Meeting organisational requirements vs spending more time providing care for older adults

I must meet organisational requirements (e.g., up-to-date notes, up-to-date statistics, number of up-to-date assessments, workload assessment). However, in meeting these organisational requirements, I reduce my involvement with older adults.

Following the normal procedure for allowing transitions to long-term care homes vs transgressing the procedure for a patient-centered outcome

I should stick to the transitions to long-term care homes formal processes. However, by respecting this process, I feel that older adults would end up in long-term care homes that do not correspond to their needs (e.g., far from their informal caregivers) and would experience a dehumanizing process. As a result, I transgress the process (e.g., filing a request when it’s not yet time for transitioning, changing older adults from one home to another so they can get their first choice, which requires me to break confidentiality rules).