This thesis examines the effects of the recent restructuring of home care on service provider organizations (SPOs), workers and clients in Ontario and England. Restructuring entailed the reorganization of service delivery into a home care market with services delivered by both nonprofit and for-profit organizations, and a change in the substance of the work as both jurisdictions shifted services from institutions to communities. This has occurred while care is rationed, as each government demands that local authorities managing the contracts balance their budgets.The experience of one community in each jurisdiction demonstrates how the implementation of government policies can play out. The structural architecture created by government policy delimits the field of action in which local delivery networks operate. Both the quantity of and the mechanisms for funding intersect with this architecture and affect outcomes.The service and the expert knowledge that SPOs hold have become market commodities. SPOs expert knowledge has become intellectual property that constitutes a competitive advantage. This can get in the way of sharing best practices within the sector. The treatment of service as a commodity means its boundaries---i.e. what constitutes appropriate care---can be contested by workers, SPOs, clients and local authorities based on its cost.As service providers must survive in the private market, they must be lean, flexible organizations. This has led to the casualization of the labour force and a low wage labour market. In periods of full employment these conditions make it difficult to recruit and retain workers.The distance between central governments and local authorities and the marketized relationship between local authorities and SPOs all get in the way of governments gathering and responding to policy feedback. Without effective participatory architecture designed to generate feedback from the bottom up, decentralized delivery networks will operate in a suboptimal way.