Social reproduction as social infrastructure: “Good treatment” of English-speaking older adults in Québec Open Access

Bientraitance or “good treatment” is becoming a central concept in policymaking on population aging in the province of Québec. Initially introduced in government documents addressing mistreatment of older adults, good treatment is defined as:

Clearly aligned with dominant concepts in healthcare environments, particularly person-centered care (Éthier et al., 2022), the Québec Government has recently produced documents promoting good treatment in all contexts (2023), focusing specifically on good treatment of older adults in the community in its latest publication (2024).

The policy move of promoting good treatment of older adults in the community must be politicized and situated within the current context, which has been marked by devolution of policy responsibility in the realm of population aging to the local level and an attendant focus on the ideal environments in which to age. A trend that is deeply entrenched in the Québec context (Joy et al., 2020), the provincial policy push for good treatment in the community appears to be underpinned by the tacit assumption that there exists a rich social infrastructure of organizations and actors in place that is available to address the needs of older adults. This assumption ignores the ways municipal governments and the community nonprofit sector have been affected by decades of neoliberal austerity which has left them with precarious finances, threadbare policy and program capacity, and burgeoning demands to address myriad crises such as housing precarity and food insecurity (Joy and Vogel, 2022; Shields et al., 2024). It also overlooks who is engaging in the crucial labor of supporting older adults under these conditions by promoting localized support while failing to adequately acknowledge and examine the bedrock of gendered labor on which much of it is built.

In this article, we explore the critical social reproductive labor provided through community nonprofit organizations (CNPOs) offering programs and services to a group of marginalized older adults, and how this “stretchy” ^[2] gendered work produces the “social glue” (Baines et al., 2020) that sustains these older adults. Through a nuanced account of the nature of this social reproductive work, its necessity and the challenges facing those providing it, the analysis offers important insight into the policy changes required to advance a transformative feminist political economy of good treatment of marginalized older adults in their communities. The analysis also contributes to debates on social infrastructure in social gerontology by recentering the focus from physical places to the labor that sustains and maintains marginalized older adults within and beyond the specific physical spaces where they interact with others.

Social infrastructure is a central concept in scholarship addressing how older adults can age in place (i.e. in their homes and communities) (Sha, 2023; Yarker, 2019, 2022; Buffel and Phillipson, 2024). Described as expanding the lens of the infrastructural turn from physical infrastructure (roads, buildings, etc.) toward “connection within places” (Yarker, 2022, p. 107), focusing on social infrastructure has been identified as enabling reflection upon “the kinds of sociality needed as we age and what facilities and qualities of public spaces can provide opportunities for social connections for older people” (Yarker, 2022, p. 3).

To date, much of the gerontology literature on social infrastructure has been grounded in scholarship on third places (Oldenburg and Brissett, 1982) and Putnam (1993, 2000)’s conceptualization of social capital. The focus, therefore, has been on places beyond the home or workplace (third places) that facilitate contact and potential connection, and the social relationships, networks and connections (social capital) that develop in these places. Scholarship on social infrastructure, moreover, is informed by the understanding that it is the foundation of social, economic, cultural and political life (Klinenberg, 2018), and in gerontology, social infrastructure has been identified as crucial for socialization, civic engagement and more positive health outcomes among older adults (Finlay et al., 2021). Inequitable access to spaces of social infrastructure has, in this regard, been an important focus of the scholarship on older adults (Buffel and Phillipson, 2024; Lewis et al., 2022; Yarker, 2019, 2022; Sha, 2023), with some of these scholars tracing links between these inequities and the broader neoliberal political-economic environment.

Understanding social infrastructure as place-based has allowed gerontology scholars to explore legitimate questions about how physical infrastructure shapes social interactions between older adults. It has also enabled scholars to examine which older adults experience unequal access to physical infrastructures where social interactions can take place, and the relationships between these inequities and the broader political-economic environment. However, as Hall (2020) pointed out, identifying social infrastructure as place-based has obfuscated the gendered, reproductive labor of social infrastructure because centering physical and material structures diverts attention from the practices and people that maintain and sustain social infrastructure. The overall effect, Hall argues, has been to mask and dismiss “the labour that enables societies and economies to function” (p. 89) because it is the social reproductive labor within and beyond the physical places where we directly interact with others that maintains and sustains us.

Feminist scholarship on social reproduction has long worked to render this often invisibilized labor visible. It was initially grounded in the disruption of gendered assumptions about the separate spheres of home and work, wherein the reproductive labor occurring in the home was not only taken for granted and undervalued but also detached from an understanding of the broader capitalist economy (see Luxton and Bezanson, 2006). Through this scholarship, social reproduction came to be recognized as the work of sustaining and maintaining workers and nonworkers, including the reproduction of new workers (children) (Bhattacharya, 2017), and as fundamentally involving care work. This care work, moreover, is recognized by feminist scholars as “almost always considered women’s work” (Armstrong and Braedley, 2013, p. 11) and, thus, tied to gendered assumptions about women’s caring “nature” and the “effortlessness” (lack of skill and value and limits) of the work (see Armstrong, 2013). It is in demonstrating that this care work is skilled and crucial to everyday well-being and the functioning of our broader society and economy, as well as the costs of performing this gendered work in a capitalist society, that this feminist scholarship seeks to intervene.

Following this approach to understanding the social infrastructure sustaining older adults, the analysis presented in this article builds upon scholarship focusing on the specificities of social reproduction in the nonprofit community sector. A sector for which it is “difficult to find work-linked theory that captures the dynamics of care work […] particularly the social bonds that workers recreate every day in various forms and iterations” (Baines et al., 2020, pp. 449–450), this scholarship focuses on the unique ways that women nonprofit care workers create and sustain social bonds in the context of a neoliberal political economy. In particular, the following applies both Baines', (2006) analysis of how neoliberal governance leads the community nonprofit sector to operate according to (the assumption of) the “endlessly stretchable capacity of women to provide care work” (p. 130) as well as Baines et al.’s (2020) analysis of how this work produces the “social glue” that sustains individuals and builds communities and the bonds between them.

The research project discussed in this paper was grounded in questions about the good treatment of older English-speaking adults in their community. It builds upon scholarship that recognizes the need to go beyond policy definitions of the good treatment of older adults through “exploration of how good treatment is understood and practiced by those directly involved in giving and receiving care” (Éthier et al., 2022, p. 1703). Accordingly, participants in the project were asked to provide their perspectives on the good treatment of older English-speaking adults.

The research was carried out in collaboration with the Community Health and Social Services Network (CHSSN) and focused on their Senior Wellness Initiative (SWI). The SWIs are “community-run programs that aim to maintain and improve the health and well-being of English-speaking seniors, increase access to knowledge of health and social services, and decrease social isolation through purposeful and informed programming” (CHSSN, 2024). Through funding from the provincial government, the CHSSN supports SWIs in over 30 community organizations across Québec.

English-speaking older adults in Québec are a group with significant needs. Despite speaking the language that dominates North America and the world more broadly (Phillipson and Skutnab-Kangas, 2017), shifts in Québec toward “the demolinguistic ascendancy of the Francophone majority in Quebec” (Bourhis, 2008, p. 135) have been ongoing since the Quiet Revolution of the 1960s. These changes have led to important linguistic challenges for older adults in the province, particularly with regards to health and social services (see Éthier and Carrier, 2023; Lord et al., 2024) and their related repercussions [e.g. medication errors/inappropriate treatment (Bartlett et al., 2008), increased anxiety when seeking help (Zhao et al., 2019), and lack of awareness of programs and services (Quebec Community Groups Network, 2023)], all within a healthcare system facing broader systemic challenges tied to neoliberal policies (Chaput-Richard, 2024).

Older English speakers in Québec also face higher rates of poverty than French-speaking older adults (Bell, 2025; Éthier and Carrier, 2022) and often struggle with digital exclusion (Lord et al., 2024). They are more likely to belong to racialized groups (Bell, 2025; Johnson, 2023) who face race-based marginalization (Fang et al., 2024; Nweze et al., 2023) and have access to fewer informal caregivers due to the outmigration of their children from the province (Éthier and Carrier, 2023; Williams, 2021). The needs of this group are, in sum, rather extensive, and recent research “highlight[s] a potential burden associated with the involvement of the English-speaking community in enabling English-speaking OAs [older adults] to access health and social services” (Williams, 2021, p. 5), particularly for the women in these communities who “fill the gaps” (Bell, 2025, p. 6), many of whom are themselves older adults (Johnson, 2023).

Given the significance of the needs of English-speaking older adults and evidence indicating that English-speaking communities (particularly the women in those communities) face challenges trying to meet these needs, the research sought to better understand the good treatment of older English speakers in Québec in the context of the government’s recent promotion of good treatment for older adults in their communities.

Three sets of data were collected after the research project was granted ethics approval by Concordia University’s Office of Research.

The first set was collected through sociodemographic questionnaires distributed to participants at four world cafés to identify who participates in the SWI programs. In total, 133 people completed the questionnaires. Those who completed the questionnaire were almost all 60 years of age and older (95%) and identified as straight (97%). The majority were also women (85%), were most comfortable speaking English (70%), and had an annual income of $40,000 or less (73%), with many living on less than $20,000 a year (37%) ^[3]. A little over half identified a form of Christianity as their religious affiliation (53%) and as having an education level of high school or elementary school (51%). The most common impairments experienced by respondents related to pain (25%), vision (24%), hearing (19%) and mobility (17%). Most participants identified as white (60%); however, one world café was entirely composed of individuals belonging to the black community (n = 22).

The world cafés, a dialogic, informal, community consultation method that allows for the collective exploration of ideas about shared issues from the “bottom-up” (Löhr et al., 2020), were held at the four different sites where the sociodemographic questionnaires were circulated. To include participants from diverse urban settings, two of the world cafés were held at community organizations in a large metropolitan area, one was held with community organizations in a suburb of a large metropolitan area, and the other with a community organization in a regional/nonmetropolitan medium-sized town. Recruitment for the world cafés was supported by the CHSSN and the community organizations directly providing the SWI programs, the latter having incorporated the timing of the world cafés into their program schedule and having offered explanations of the broader research project and research participation to potential participants several weeks prior to the world cafés. Participant consent was reviewed before beginning the world cafés and those who chose not to participate were invited to share the food and refreshments provided. A total of 163 people chose to participate, the vast majority of whom were older adults (over 90%), though caregivers and family members, volunteers and staff also participated. Three questions were asked at each world café to better understand how participants define good treatment ^[4] of themselves/older adults (Q1), and how it is practiced through the SWI programs (Q2) and in their broader communities (Q3). Participants discussed each question in small groups before exchanging their ideas with the larger group and moving on to discussing the next question. Participant and researcher notes were collected after the discussions and used as research data.

The third form of data collection involved eight qualitative interviews with executive directors (n = 3) and SWI program coordinators (n = 5) from the community organizations that participated in the four world cafés. These semistructured interviews were conducted in the spring of 2024 using videoconferencing and, like the world cafés, were oriented toward understanding the perspectives of those directly involved in providing good treatment of older English-speaking adults. These interviews were added to the study following the world cafés because of the research team’s inability to tease out these perspectives from that data and their observations of the overwhelmingly feminized makeup of the workforce ^[5]. Similar to other research using the world café method (Éthier et al., 2022), our team sought to capture a more in-depth understanding of key perspectives that were not well-represented in that form of data collection through focused interviews.

We conducted a descriptive analysis of the sociodemographic data and then adopted a reflexive approach to thematic analysis (Braun and Clarke, 2019) to analyze the world café data and the interview data. All three researchers (Smele, Joy and Fortune) individually conducted an initial analysis of the world café data to identify key themes. After this initial step, they met to discuss their analyses and come to a consensus about core themes. The interview data was then analyzed according to the themes identified in the world café data as well as those that emerged from an abductive approach to analyzing the interview data (Tavory and Timmermans, 2019). The latter was informed by the research team’s observations about the gendered makeup of those providing good treatment to English-speaking older adults and scholarship on gendered labor.

The results of our data reveal that providing good treatment to older English-speaking adults in Quebec involves stretchy social reproductive labor that sustains individuals while also building their connections to their smaller (SWI-based) and broader communities. This labor is stretchy because while some of it takes place within the SWI programs, it also extends beyond the programs, both in terms of paid and unpaid work, and how it seeks to meet needs and build collective responsibility beyond the program itself. These forms of labor have been grouped below under four themes. The first two themes focus on sustaining individuals:

1. interpersonal recognition and attentiveness; and

2. attendance to resource and support needs.

The second two themes focus on building communities:

1. deep reflection and action to create spaces that are shared, safe and adapted; and

2. attending to good treatment as a broader responsibility.

In their responses to definitional questions about good treatment of older English-speaking adults, world café participants and interviewees tended to define good treatment in terms of interpersonal interactions between older adults and those directly providing the SWI programs. Their definitions aligned around several key types of interaction. While the term respect was often used to describe these interactions – such as respect for age (e.g., prioritizing older adults’ needs), for personhood (i.e. not treating them as “a number” or “a disease”), and not engaging in infantilization or other forms of discrimination (e.g., racism) – both sets of participants emphasized recognition and various forms of attentiveness to a greater extent. Regarding recognition, valuing older adults by ensuring they get to speak for themselves, they are asked their opinions and they are recognized for what they (can) contribute to the SWI programs and their wider community, was identified as a crucial element of good treatment in the world cafés. This was echoed in the interviews. One interviewee described how good treatment of older adults means “making them feel that they have a voice, or they can speak up for themselves, or they can tell us what they need, and they know they are being recognized” (Participant 2). Another summed up her approach to good treatment as “making them a person of value” (Participant 4) by recognizing what it is they can contribute. For one interviewee, recognition was as simple and crucial as greeting older adults at the front door to let them know “I’m so glad you came. I’m so happy to see you” (Participant 3).

In addition to recognition, world café and interview participants defined good treatment as attentiveness. World café participants described attentiveness as deep listening and patience that involves showing empathy, interest and concern for older adults. They also described it as sensitivity to potential and actual needs without the presumption they already exist. One interviewee reflected several of these ideas in her explanation of good treatment as “giving empathy in treating them [older adults] in a way that they’re like, you’re equal too [… so] you’re not assuming right away that they need help. You should ask them” (Participant 2). Several interviewees described intentionally taking time to learn about each older adult attending their SWI program and “really listening to them, and I mean actually listening” (Participant 1), and the ways that older adult participants in the SWI program engaged in these types of interactions with each other as well. An interviewee also described her approach to attentiveness as responding to “the sort of social backdrop […] what people go through” (Participant 8). For her, “be[ing] sensitive to what could have been a lot of undervaluing and invisibility before they get to us” (Participant 8) was fundamental to treating older adults well, and another participant described how an older man at her SWI program opened up to her about having contemplated suicide prior to attending her program, demonstrating how crucial these kinds of attentive interactions can be for the older adults participating in the SWI programs.

Though the definitions of good treatment that were offered by world café and interview participants focused largely on these interpersonal interactions, the responses to questions about how good treatment of older English-speaking adults is practiced elicited reflections on other elements of good treatment, including attendance to resource and support needs. In some cases, attendance to these needs was fundamentally part of the SWI program. For example, world café participants, most of whom were far from affluent (as demonstrated by the demographic data), described their deep appreciation for the various opportunities to learn through free or low-cost workshops, conferences and activities, and for the sources of entertainment, such as books and films, available to them through the SWI program. They also identified the support they received through the SWI program to better understand and access services, particularly local information about their municipality and help accessing healthcare in English, as good treatment.

Though interview participants also described attendance to these resource and support needs as good treatment, they provided several examples of how their practices of good treatment meant attending to resource and support needs outside the scope of the SWI programs. Two of the crucial resource needs our interview participants identified were transportation and digital supports. Across interviews, participants described their preoccupation with transportation to their SWI programs and several creative ways they had tried to address this “huge barrier” (Participant 8) with one interviewee describing a solution as having staff arrive before the SWI program’s scheduled time to accommodate an older adult’s limited transportation options. Interviewees also described finding ways to provide iPads and support access to computer courses for those who are “homebound” (Participant 6), as well as providing support with online appointment booking, and one participant explained that many of the older adults attending her program do not have email or Wi-Fi and emphasized how challenging it has been to try to “really build from the ground up with them” (Participant 1). One final resource need, that of having food to eat, was also mentioned by an interview participant who described herself as “providing that subtly with dignity [by] packag[ing] food for people who we know might be struggling a bit more than others and just put it in their bag.” As she explained, “you know no one sees it. No one has to know” (Participant 3). Similar to the resource needs met through the SWI programs, these good treatment practices were tied to the material circumstances of the older adults and efforts to mitigate them.

Accounts of good treatment as attendance to older English-speaking adults’ support needs were, similarly, largely exemplified through practices that extend beyond the bounds of the SWI program. Unlike the good treatment practices involving attendance to material needs, these practices were fundamentally informed by concerns about older adults’ lacking networks of support. For example, one executive director who specifically articulated this concern described phoning the hydro company after a large sum of money had been automatically taken out of an older adult’s account to try to help them retrieve the sum. A similar example was provided during one of the world cafés and involved staff removing a bird from an older adult’s home. Interview participants also described making check-in phone calls to older adults during the months their SWI programs are closed, and several examples of supporting individuals who no longer attend their SWI program, such as English-speaking older adults who moved into long-term care residences, as other examples of their good treatment practices, all of which also extended beyond the actual SWI program.

Our participants also identified the creation of shared, safe and adapted spaces as another component of good treatment of older English-speaking adults. For world café participants, these environments are spaces where coffee, tea and meals are shared and where older adults feel at peace and do not experience fear expressing themselves. Part of the latter was tied to the opportunity to express themselves in English at the SWI programs. Several older adults provided examples at the world cafés of how speaking English to various service providers had been negatively received and expressed related worries about recent changes to language policies in Québec. Interviewees similarly stressed the importance of their work to create spaces where these older adults can speak and interact with others in English without “discomfort” (Participant 5).

The interviewees described other elements of good treatment that are tied to the creation of particular kinds of environments as well, particularly safe and adapted environments. They expressed, for example, how they work to create environments where older adults do not feel judged based on what they do and do not know, or what they can and cannot do. As one interviewee put it, the aim is to create “a very safe place for everybody to come all the time […where] there’s no right or wrong” (Participant 4). Interviewees also described how their programming and on-site practices are responsive to the needs of older adults who already attend as well as those they wish to include. For those already attending SWI programs, this work included the creation of grief groups for widowed women; active “openness” and “mak[ing] space for people [currently attending] who don’t fit in” (Participant 8); “always monitoring” to intervene in racist interactions (Participant 3); and, in the case of the SWI program for older English-speaking black adults, the very running of that program because it specifically aims to meet the needs of a group that is not well-served by other organizations. With regards to the latter group of older adults who interviewees sought to include, they described various efforts to create spaces that attend to men’s interests and participation (men’s shed-type activities; offering support to develop life skills (e.g. laundry and washing dishes); providing mentorship opportunities; and having a man on staff to enable disclosures that might not otherwise occur). One interviewee also described her efforts to undo the centering of white, middle class older adults in the SWI program environment and working “really hard to engage the Black community, [and…] reaching out to the Indigenous populations […] because they don’t always feel safe. They don’t feel welcome” (Participant 3), demonstrating a distinctive approach to creating a safe space that addressed broader racial inequities.

One final key element of participants’ understandings of good treatment of older English-speaking adults addressed the broader nature of this responsibility. World café participants largely focused on the substance of these broader responsibilities, while interviewees focused more on the work they do to share this responsibility. For world café participants, this responsibility involved experiencing friendly and neighborly interactions with older adults in their immediate environment; local communities planning multiple activities for them and offering a variety of spaces where they feel welcome and safe; and certain forms of service prioritization (e.g. in bank and grocery store lineups and for parking). They also identified several good treatment practices directly tied to public services, programs and resources, including the provision of accessible infrastructure (e.g. ramps and snow removal) and free transportation, the availability of affordable housing in proximity to services, well-maintained social housing and healthcare services that are available, accessible and reliable that can be provided in English.

In their descriptions of this broader responsibility, interview participants were much more focused on the work they do to share the responsibility to provide good treatment to older English-speaking adults. For one interviewee, part of this work involved taking phone calls from family members outside of work hours to help support their role in the lives of those participating in the SWI program. More generally, this work was described as engaging with various tables and committees, other community organizations and different levels of government to advocate for older English-speaking adults’ needs. As one participant explained, “I do a lot of the networking, a lot of the lobbying” (Participant 6). Interview participants identified limits to their networking and advocacy at the level of other community organizations and municipalities, however, due to resource limitations (including staff turnover) and expanding needs facing both sectors. They also recognized the need for greater funding from higher levels of government to support their programs and services and the significant work they do to have information readily available for their funders as “the soldiers in the communities” (Participant 4) who both know the needs of older English-speaking adults and require adequate financial resources to meet these needs, while also avoiding burnout/ensuring staff well-being.

Our research reveals that the older adults and SWI program providers who participated in our study do not require government guidelines telling them how the community should engage in good treatment of older adults. On the contrary, it demonstrates that government and policymakers have much to learn from a close examination of what marginalized older adults identify as good treatment and the current provision of good treatment to older adults by CNPOs. Our findings are limited to the four sites at which we conducted our study and to a specific group: English-speaking older adults in Québec. While this population faces unique needs as a linguistic minority, as well as other material, racial justice and support network related-needs (Bell, 2025; Éthier and Carrier, 2022, 2023; Johnson, 2023), these findings nonetheless provide insight into how good treatment is understood by, and practiced for, marginalized older adults in their communities. In particular, our results advance an understanding of the provision of good treatment as work involving stretchy social reproductive labor that sustains individuals through interpersonal recognition and attentiveness, and through attendance to their resource and support needs, while also building their connections to their smaller and broader communities.

This account of the good treatment of older adults, thus, helps to reframe understandings of community away from the abstracted and idealized notions of the local that have underpinned neoliberal devolution of responsibility for population aging. It also shifts attention away from focusing solely on physical places as the key sites of social infrastructure for older adults (and others) and points to the need to pay attention to the various practices and particular people involved in maintaining and sustaining older adults, and how they do so within neoliberal environments. Indeed, the stretchy social reproductive work the women coordinators and executive directors provided was in many ways a form of resistance to the impacts of neoliberalism (and other, intersecting power relations, such as racism) on the lives of English-speaking older adults, as well as a means to address their absence of familial supports. However, participants’ comments about burnout and staff well-being clearly point to limits to which this work can be stretched, and to the negative impacts of this stretchy work on those providing it.

Public policy must support the good treatment of older adults, and this support must be grounded in recognition that neoliberalism does not align with this broader goal. Neoliberal policy choices that are increasing the experience of insecure, precarious aging (Grenier and Phillipson, 2018; Joy and Vogel, 2022; Joy, et al., 2025; Shields et al., 2024) must be redressed as a key element of government support for good treatment, particularly the good treatment of marginalized older adults facing intersecting forms of precarity, such as older English-speaking adults in Québec. At the same time, support for good treatment of older adults must begin from a deep understanding of how it is practiced and who engages in this crucial work. Echoing arguments made in previous research on good treatment in residential care environments (Éthier et al., 2022; Éthier et al., 2024), ensuring good treatment of older adults means appropriately supporting those who provide it. In this way, direct policy support for good treatment of older adults in their communities involves stabilizing adequate funding for programs run by CNPOs so that they can serve older adults without relying on women continually stretching their care work to try to meet the ever-increasing needs of older adults. In practice, this would ultimately involve a transformative feminist political economy of good treatment of older adults that includes funding to hire sufficient staff and to attend to the well-being of that staff, as well as funding to support their broader, community-building work that relies on their deep expertise. These transformations are imperative if the goal is to sustain this crucial work of providing good treatment to older adults.

The research team sincerely thanks Erica Botner, all of the older adults, and the staff and executive directors who participated in this project.