Divergent Paths: Ideas, Bureaucratic Rationality, and the Ownership Mix of the Public Nursing Home Systems of Ontario and British Columbia

Abstract

The ownership-mix of welfare-state services shapes care quality and regulatory costs, yet its formation remains undertheorized in welfare-state and non-profit scholarship. This dissertation examines why Ontario and British Columbia adopted opposing ownership-mix models for publicly funded nursing homes during the formative period of welfare-state modernization (1940s-1970s), despite shared liberal welfare institutions, conservative governments, federal funding opportunities, for-profit-dominated sectors, and despite Ontario's initially larger non-profit base. Prevailing social policy theories cannot explain the divergence, several predicting the reverse in at least one case.

Drawing on internal government archives, the study employs subnational comparative process-tracing within a framework integrating historical institutionalist, ideational, and Weberian theory, showing how distinct ideas and bureaucratic rationalities filtered a shared modernization objective into opposing policies. British Columbia's substantively rational 'caring bureaucracy' persistently advanced principled ideas of a high philosophy of care and framed poor care as moral failure, pressing a free-enterprise executive towards non-profit provision as the only means of reconciling care commitments with cost-efficiency. Ontario's instrumental-formal rationality privileged the causal belief that for-profit outsourcing under measurable physical standards and minimal care oversight would minimize regulatory, capital, and operational costs, a belief officials diligently operationalized, sometimes voicing concerns but deferring when overruled. This logic was reproduced across multiple windows of opportunity and entrenched through institutional layering and self-reinforcing feedback. Ontario promoted for-profit expansion, froze Homes for the Aged, and declined federal non-profit construction funding that British Columbia leveraged, alongside other measures, for non-profit nursing homes while restricting for-profit growth, culminating in a reform-resistant for-profit-dominated sector in Ontario and a non-profit-dominated one in British Columbia.

These findings date each province's ownership-mix foundations decades earlier than prevailing paradigmatic and leader-centred accounts, specify how ideas conditioned by bureaucratic rationality shape policy direction, and provide rare systemic evidence of both rationalities shaping policy formulation, extending care ethics beyond front-line administration.