Older people's exercising of choice in long-term care: a comparative analysis of England and Japan

Abstract

There has been an increasing emphasis on choice for older people in long-term care in both England and Japan. However, despite the emphasis on the importance of choice, the perspectives of older people have been given little attention. Considering national and local policies in Bristol, England and Kyoto, Japan, the article explores how older people are exercising (and not exercising) choice in care practice through examining the perspectives of the older people themselves, as well as key informants in the field. Empirical data were collected from interviews with older people and key informants in the two countries, and were analysed using qualitative and comparative approaches. Choice in policy is regarded as a mechanism of the market with an assumption of the independent autonomous individual who can exercise ‘rational choice’. However, the findings have reflected older people's relational decision-making, which does not conform to the rational model of decision-making, and illustrates the value of ‘interdependence’. The findings from care practice have shown that choice was considered an important value in involving older people's views and ensuring their needs are met sensitively and respectfully. The findings also suggested that consideration of the psychological aspects of choice is an important aspect of ‘care’, facilitating the inclusion of older people's views in the process of making judgements, in order to meet their needs.

Exploring food choice and flexibility practices among staff and residents at care homes in Denmark

“…Based on this, it is important to consider how food choice and flexibility practices do not necessarily mean providing all residents daily with a multitude of different choices of what to eat, at what time, where and with whom (Milte et al , 2017). Instead, food choice and flexibility practices also include concrete ways of continuously relating to the residents, finding alternative ways or methods of listening, as well as responding to the voices of the residents in order to understand their needs, wishes and preferences (Tutton, 2005; Edvardsson et al , 2010; Hung and Chaudhury, 2011; Rodgers et al , 2012; Wada, 2016; Milte et al , 2017). Those with cognitive impairments or limited ability to express themselves verbally (which is actually the majority of the residents in care homes) and those who never ask for anything out of politeness, might also be included through care providers gaining knowledge of what is important for the residents.…”

“…In recent decades, the importance of providing person-centred or individualised care for older people has been clearly stated, emphasising the essentiality of autonomy, self-determination and participation in everyday life decisions (National Board of Health and Welfare (Sweden), 2012; Rodgers et al , 2012; Fine, 2013; AGE Platform Europe, 2017). Providing choice and flexibility opportunities and satisfying individual preferences (Winterburn, 2009; Wada, 2016) also entered the agenda as a response to the goals of providing non-institutional or more home-like care environments (Dorner, 2010; Milte et al , 2017).…”

‘Pathways to choice’ of care setting

“…Second, the rational choice approach focuses on the individual consumer, thus sidestepping the importance of other actors in shaping choice-making. An older person's engagement in choosing a care option or setting, for example (Wada 2016), can be influenced by interactions with broader networks of family, friends, and service or medical staff (Eichler and Pfau-Effinger 2010; Fernandez-Carro 2016; Groger 1994; Shawler, Rowles and High 2001). Equally, some evidence shows that making choices in tandem with others can enhance a sense of empowerment, particularly if they can be shared or delegated (Sciegaj, Capitman and Kyriacou 2004; Sixsmith 1986).…”