We explored personal autonomy issues within family caregiving relationships and found little evidence of significant autonomy conflicts. Findings did suggest, however, that family members were more sensitive to autonomy issues than were their frail older relatives and that both groups defined the disability itself as the major impediment to autonomy in later life. Findings support the usefulness of an expanded definition of autonomy, emphasizing the importance of goal-directed behavior, which may be inhibited by intrinsic conditions as well as external forces.

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The author proposes that, in practice with older adults, the social work profession revisit its traditional allegiance to the person-in-situation paradigm and redress an imbalance that has obscured older clients as persons in their own right. The case is made that older adults and their subjective reality must be restored as a focus of social work practice if the profession is to play a significant and much-needed role in community-based services to a growing future population of older persons living in their own homes and directing their lives but in need of support. Building on the practice wisdom of the past and current generic models of social work practice in North America, guidelines are presented as a starting place for building practice models applicable to older clients. The broader context of community health and social services programs is examined from the perspective of the obstacles to and potential opportunities for increasing professional social work services to older persons and their families.