Feeling in control: comparing older people's experiences in different care settings

The promotion of choice and control for older people is a policy priority for both health and social care services in the UK. For older people receiving care, it seems that having control is less to do with managing by oneself and more to do with having control over the delegation of their care and responsibilities and influencing how and when care and support is delivered. What older people describe as being important to them is having control over their daily lives with personalised, responsive services, regardless of how their funding is arranged. Increasingly, we have seen a move away from institutionalised care (e.g. in care homes) towards ‘enablement’, with more services being delivered in community-based settings, with the aim to help people maintain their independence in their own homes for as long as possible, receiving domiciliary care and adaptations to their home as needed. Ageing in place can be problematic, however, not least because much of Britain's housing stock is unsuitable for adaptation. Restricted to living in only one or two rooms, many older people report being prisoners in their own homes, socially isolated and at risk from depression and anxiety. Housing with care, such as extra care housing or continuing care retirement communities, has been promoted as a purpose-built, community-based alternative to moving into residential care for older people. It aims to meet the housing, care and support needs of older people, while helping them to maintain independence in private accommodation, and is seen as a positive option for older people in current social care policy.