Choice and Decision-Making in Swedish Elderly Care

The Act on System of Choice (2008) has resulted in increased expectations on the Swedish municipalities to implement customer-choice models in elderly care. Proponents of choice models predict the empowerment of older people as well as improved quality. However, knowledge of the impact of competition, privatisation and choice models on eldery care quality are limited.  Hence, it is uncertain how older people act within customer-choice models, both as regards to how active they are in the situation of choice and as to what extent they base their considerations and choices on available information. It has been showed that older peoples’ choices and decisions within elderly care are not isolated instances, but rather have the character of ongoing processes in which choices are constantly negotiated and renegotiated depending on changing circumstances and priorities. Few older people change their choice of elderly care provider, and if so it is usually because the providing firm ceases. Research also shows that older people who are in most need of care may be so cognitively and/or physically affected that they have great difficulties to act as rational consumers. In addition, research show, that rather than acting as willing customers in an elderly care market, older people are trying to accept that they may need help.  The introduction of choice models involves changing roles for older people in need of care, their relatives and local care managers.The aim of this study is to investigate older peoples’ decision making in the Swedish elderly  care context with respect to the grounds and conditions for decisions that contribute to well-being and preserved autonomy. Three municipalities with different models according to older peoples choise and influence in elderly care have been selected for the study. Preliminary results from interviews and participant observations will be presented.