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Short abstract:

Community-based healthcare requires care providers to convert the intricacies of daily life into metrics that are legible to the state. We examine the wide variation in existing assessments of functional capacity to problematize the expectation that everyday life can be standardized.

Long abstract:

Care provision today is characterized by two major historical shifts. The first is the movement of people from care in large institutions where the physical space for caregiving and its methods were highly standardized, to a community based model that emphasizes individualization and personal choice. The second is the increasing use of metrics to document and justify caregiving in our modern neoliberal healthcare system, where people with disabilities and the elderly who require home care qualify for support on the basis of quantifiable medical and financial need.

This paper examines the tension that emerges between need for measurement and the principles of patient-centered care in the United States. Drawing on content analysis of mental competence and functional capacity tests, we argue that the confluence of individualized care and processes of quantification requires care providers to convert the intricacies of daily life into metrics that are legible to the state. While the federal government requires the use of metrics to allocate and design care, there are hundreds of assessment tools used to measure the activities of daily living in the United States. These tests vary widely in who administers them, what they measure, and how they quantify. We examine the variation between these tests to problematize the expectation that everyday life can be standardized.