Exercising Choice in Long-term Residential Care

Abstract

Expanding choice has long been a central feature of health care reforms, with a focus on choices for individual patients and residents. However, choices are structured by factors often beyond the control of individuals or even particular care homes and by the extent to which staff or unpaid providers can build relationships that provide the basis for appropriate decision-making. Moreover, there is a fundamental tension between the need for routine, for evidence-informed decision making and for safety on the one hand and on the other, responding to individual choices and events that disrupt routines on a regular basis. Based on our team research on long-term residential care in six high income countries, Exercising Choice in Long-Term Residential Care identifies conditions that set the context for exercising meaningful choices for residents, staff, families and managers in long-term residential care. We start from the assumption that there will be events and choices that do not conform to routine patterns. And we assume that the conditions of work are the conditions of care.