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In this chapter we explore contextual and social mechanisms in rural areas in Sweden, Norway and Ontario, Canada, and how they create and shape interactions between older people in care homes, their families, the staff and the volunteers. Geographical and physical conditions frame the outer context and impact service provision and how people relate to each other. As was pointed out in Chapter 1, there are similarities and distinctions between the availability of care home beds, staff, competence and volunteers that both inform and complicate comparative analysis across jurisdictions. We draw on similar characteristics in four rural sites across jurisdictional and regional boundaries, condensing and analysing central themes that emerged in interviews and fieldnotes.

There are significant differences regarding how services are arranged and organised nationally, regionally, municipally and geographically. This affects home care provision and the level of needs required to be assigned to move into a care home (Chapter 2). As Martens (2017) argues, in Norway, region and postal code affect the availability and amount of care provision, and care is not equally distributed among older people in the country. In our experience, there are also significant differences in access across different regions in both Ontario and Sweden.