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‘Pathways to choice’ of care setting

Published online by Cambridge University Press:  14 September 2017

Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK.


This article aims to encourage critical reflection about the limitations of the rational choice approach as an explanatory insight to understanding older people's choice-making about their health or social care requirements. It develops an interpretive framework examining how older people engage in the process of choice-making when selecting a care option. Choice-making is conceptualised as a temporal, processual phenomenon, influenced by others, and characterised by an individual's behavioural responses to changing circumstance and lifecourse events. Data are from qualitative interviews with 29 older adults whose choice of care option involved moving to an extra-care setting in Wales (United Kingdom). Transcripts were coded using in-case and constant-comparison approaches, and analysis was undertaken using concepts of engagement and temporality as elements of the choice-making process. Using an inductive approach, a typology of six different ‘pathways to choice’ of care setting was identified; these findings suggest that choosing a care option in later life is a diverse, interactive and time-bound social phenomenon, inadequately captured by the rational choice approach where it is understood more as an individualised, linear and logical process. Recognising that choice-making evolves through time as part of a process shaped by others means service providers will be better positioned to offer opportunities for more preventative-focused interventions which empower older consumers to make planned and informed choices about care options.

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Andersson, K. and Kvist, E. 2014. The neoliberal turn and the marketization of care: the transformation of eldercare in Sweden. European Journal of Women's Studies, 22, 3, 274–87.CrossRefGoogle Scholar
Andrews, J.-A., Manthorpe, J. and Watson, R. 2004. Involving older people in intermediate care. Journal of Advanced Nursing, 46, 3, 303–10.CrossRefGoogle ScholarPubMed
Aspinwall, L. G. and Taylor, S. E. 1997. A stitch in time: self-regulation and proactive coping. Psychological Bulletin, 121, 3, 417–36.CrossRefGoogle ScholarPubMed
Ayalon, L. and Greed, O. 2016. A typology of new residents’ adjustment to continuing care retirement communities. The Gerontologist, 56, 4, 641–50.CrossRefGoogle ScholarPubMed
Bamford, C. and Bruce, E. 2000. Defining the outcomes of community care: the perspectives of older people with dementia and their carers. Ageing & Society, 20, 5, 543–70.CrossRefGoogle Scholar
Baumker, T., Callaghan, L., Darton, R., Holder, J., Netten, A. and Towers, A.-M. 2012. Deciding to move into extra care housing: residents’ views. Ageing & Society, 32, 7, 1215–45.CrossRefGoogle Scholar
Benten, J. and Spalding, N. 2008. Intermediate care: what are service users’ experiences of rehabilitation? Quality in Ageing and Older Adults, 9, 3, 414.CrossRefGoogle Scholar
Brecht, S. B., Fein, S. and Hollinger-Smith, L. 2009. Preparing for the future: trends in continuing care retirement communities. Senior Housing and Care Journal, 16, 1, 4762.Google Scholar
Brown, T. and King, P. 2005. The power to choose: effective choice and housing policy. European Journal of Housing Policy, 5, 1, 5975.CrossRefGoogle Scholar
Burholt, V., Nash, P., Doheny, S., Dobbs, C., Phillips, C., Phillips, J., Marston, H., Hillcoat-Nallétamby, S., Evans, S. and O'Mahoney, S. 2011. Extracare: Meeting the Needs of Fit or Frail Older People? Centre for Innovative Ageing, Swansea University, Swansea, UK.Google Scholar
Carder, P. C. and Hernandez, M. 2004. Consumer discourse in assisted living. Journals of Gerontology: Psychological Sciences and Social Sciences, 59B, 2, S5867.CrossRefGoogle Scholar
Clarke, J., Newman, J., Smith, N., Vidler, E. and Westmarland, L. 2007. Creating Citizen-consumers. Changing Publics and Changing Public Services. Sage, London.Google Scholar
Collopy, B. J. 1988. Autonomy in long term care: some crucial distinctions. The Gerontologist, 28, supplement, 1017.CrossRefGoogle ScholarPubMed
Collopy, B. J. 1995. Power, paternalism and the ambiguities of autonomy. In Gamroth, L. M., Semradek, J. and Torquist, E. M. (eds), Enhancing Autonomy in Long-term Care. Concepts and Strategies. Springer, New York, 314.Google Scholar
Cutchin, M. P. 2001. Deweyan integration: moving beyond place attachment in elderly migration theory. International Journal of Aging and Human Development, 52, 1, 2944.CrossRefGoogle ScholarPubMed
Cutchin, M. P. 2003. The process of mediated aging-in-place: a theoretically and empirically based model. Social Science & Medicine, 57, 6, 1077–90.CrossRefGoogle ScholarPubMed
Department of Health 2016 a. Factsheet 4: Personalising Care and Support Planning (updated). Available online at [Accessed 23 February 2017].Google Scholar
Department of Health 2016 b. Guidance. Adult Social Care Market Shaping. Available online at [Accessed 23 February 2017].Google Scholar
Drought, T. S. and Koenig, B. A. 2002. ‘Choice’ in end-of-life decision making: researching fact or fiction? The Gerontologist, 42, supplement 3, 114–28.CrossRefGoogle ScholarPubMed
Eichler, M. and Pfau-Effinger, B. 2010. The ‘consumer principle’ in the care of elderly people: free choice and actual choice in the German welfare state. In Greve, B. (ed.), Choice. Challenges and Perspectives for the European Welfare States. Wiley Blackwell, Chichester, UK, 7893.Google Scholar
Elster, J. (ed.) 1986. Rational Choice. Blackwell, Oxford.Google Scholar
Fernandez-Carro, C. 2016. Ageing at home, co-residence or institutionalisation? Preferred care and residential arrangements of older adults in Spain. Ageing & Society, 36, 3, 586612.CrossRefGoogle Scholar
Fine, M. D. 2013. Individualising care. The transformation of personal support in old age. Ageing & Society, 33, 3, 421–36.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. 1975. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 3, 189–98.CrossRefGoogle Scholar
Gächter, S. 2013. Rationality, social preferences and strategic decision-making from a behavioral economics perspective. In Wittek, R., Snijders, T. and Nee, V. (eds), Handbook of Rational Choice Social Research. Stanford Social Sciences, Palo Alto, California, 3371.Google Scholar
Glendinning, C. 2008. Increasing choice and control for older and disabled people: a critical review of new developments in England. Social Policy & Administration, 42, 5, 451–69.CrossRefGoogle Scholar
Granbom, M., Himmelsbach, I., Haak, M., Lofqvist, C., Oswald, F. and Iwarsson, S. 2014. Residential normalcy and environmental experiences of very old people: changes in residential reasoning over time. Journal of Aging Studies, 29, 6, 919.CrossRefGoogle ScholarPubMed
Greve, B. (ed.) 2010. Choice: Challenges and Perspectives for the European Welfare States. Wiley-Blackwell, London.CrossRefGoogle Scholar
Groger, L. 1994. Decision as process: a conceptual model of black elders’ nursing home placement. Journal of Aging Studies, 8, 1, 7794.CrossRefGoogle Scholar
Harper, R., Randall, D. and Sharrock, W. 2015. Choice. The Sciences of Reason in the 21st Century: A Critical Assessment. Polity Press, London.Google Scholar
Hillcoat-Nallétamby, S. 2014. The meaning of independence for older people in different residential settings. Journals of Gerontology: Psychological Sciences and Social Sciences, 69B, 3, 419–30.CrossRefGoogle Scholar
Johnson, R., Popejoy, L. L. and Radina, M. E. 2010. Older adults’ participation in nursing home placement decisions. Clinical Nursing Research, 19, 4, 358–75.CrossRefGoogle ScholarPubMed
Jordan, B. 2006. Public services and the service economy: individualism and the choice agenda. Journal of Social Policy, 35, 1, 143–62.CrossRefGoogle Scholar
Kite, S. and Tate, T. 2005. Choice and palliative care: what do we mean? Palliative Medicine, 19, 4, 267–69.CrossRefGoogle ScholarPubMed
Koss, C. and Ekerdt, D. J. 2016. Residential reasoning and the tug of the Fourth Age. The Gerontologist, Published online: 13 February 2016. doi [Accessed 30 August 2017].CrossRefGoogle Scholar
Kunkel, S. R. and Nelson, I. M. 2005. Consumer direction: changing the landscape of long-term care. Public Policy & Aging Report, 15, 4, 1316.CrossRefGoogle Scholar
Leech, N. L. and Onwuegbuzie, A. J. 2011. Beyond constant comparison qualitative data analysis: using NVivo. School Psychology Quarterly, 26, 1, 7084.CrossRefGoogle Scholar
Löfqvist, C., Granbom, M., Himmelsbach, I., Iwarsson, S., Oswald, F. and Haak, M. 2013. Voices on relocation and aging in place in very old age – a complex and ambivalent matter. The Gerontologist, 53, 6, 919–27.CrossRefGoogle ScholarPubMed
Lymbery, M. 2010. A new vision for adult social care? Continuities and change in the care of older people. Critical Social Policy, 30, 1, 527.CrossRefGoogle Scholar
March, J. G. 1994. Primer on Decision Making. How Decisions Happen. The Free Press, New York.Google Scholar
Means, R. 2012. A brave new world of personalized care? Historical perspectives on social care and older people in England. Social Policy & Administration, 46, 3, 302–20.CrossRefGoogle Scholar
Mitoku, K. and Shimanouchi, S. 2014. The decision-making and communication capacities of older adults with dementia: a population-based study. The Open Nursing Journal, 8, 1724.CrossRefGoogle ScholarPubMed
Moffatt, S., Higgs, P., Rummery, K. and Jones, I. R. 2012. Choice, consumerism and devolution: growing old in the welfare state(s) of Scotland, Wales and England. Ageing & Society, 32, 5, 725–46.CrossRefGoogle Scholar
Mulder, C. 1996. Housing choice. Netherlands Journal of Housing and the Built Environment, 11, 3, 209–32.CrossRefGoogle Scholar
National Health Service England 2016. Personalised Care and Support Planning Handbook: The Journey to Person-centred Care. Core Information. Care and Support Planning Working Group and Coalition for Collaborative Care, Leeds, UK. Available online at [Accessed 23 February 2017].Google Scholar
Ottmann, G., Allen, J. and Feldman, P. 2013. A systematic narrative review of consumer-directed care for older people: implications for model development. Health & Social Care in the Community, 21, 6, 563–81.Google ScholarPubMed
Ouwehand, C., de Ridder, D. T. D. and Bensing, J. M. 2007. A review of successful aging models: proposing proactive coping as an important additional strategy. Clinical Psychology Review, 27, 8, 873–84.CrossRefGoogle ScholarPubMed
Patton, M. Q. 2015. Qualitative Research & Evaluation Methods. Fourth edition, Sage, London.Google Scholar
Pope, N. D. and Kang, B. 2010. Residential relocation in later life: a comparison of proactive and reactive moves. Journal of Housing for the Elderly, 24, 2, 193207.CrossRefGoogle Scholar
Rabiee, P. 2013. Exploring the relationships between choice and independence: experiences of disabled and older people. British Journal of Social Work, 43, 5, 872–88.CrossRefGoogle Scholar
Rabiee, P. and Glendinning, C. 2014. Choice and control for older people using home care services: how far have council-managed personal budgets helped? Quality in Ageing and Older Adults, 15, 4, 219–10.CrossRefGoogle Scholar
Reed, J., Cook, G., Sullivan, A. and Burridge, C. 2003. Making a move: care-home residents’ experiences of relocation. Ageing & Society, 23, 2, 225–41.CrossRefGoogle Scholar
Rolls, L., Seymour, J. E., Froggatt, K. A. and Hanratty, B. 2011. Older people living alone at the end of life in the UK: research and policy challenges. Palliative Medicine, 25, 6, 650–7.CrossRefGoogle ScholarPubMed
Rowles, G. D. and High, D. M. 1996. Individualizing care: family roles in nursing home decision making. Journal of Gerontological Nursing, 22, 3, 20–5.CrossRefGoogle ScholarPubMed
Sciegaj, M., Capitman, J. A. and Kyriacou, C. K. 2004. Consumer-directed community care: race/ethnicity and individual differences in preferences for control. The Gerontologist, 44, 4, 489–99.CrossRefGoogle Scholar
Sergeant, J. F. and Ekerdt, D. J. 2008. Motives for residential mobility in later life: post-move perspectives of elders and family members. International Journal of Aging & Human Development, 66, 2, 131–54.CrossRefGoogle ScholarPubMed
Sergeant, J. F., Ekerdt, D. J. and Chapin, R. K. 2010. Older adults’ expectations to move: do they predict actual community-based or nursing facility moves within 2 years? Journal of Aging and Health, 22, 7, 1029–53.CrossRefGoogle ScholarPubMed
Shakespeare, T. 2000. The social relations of care. In Lewis, G., Gewirtz, S. and Clarke, J. (eds), Rethinking Social Policy. Sage, London, 5265.Google Scholar
Shawler, C., Rowles, G. D. and High, D. M. 2001. Analysis of key decision-making incidents in the life of a nursing home resident. The Gerontologist, 41, 5, 612–22.CrossRefGoogle ScholarPubMed
Sixsmith, A. J. 1986. Independence and home in later life. In Phillipson, C., Benard, M. and Strang, P. (eds), Dependency and Interdependency in Old Age: Theoretical Perspective and Policy Alternatives. Croom Helm, London, 338347.Google Scholar
Smebye, K. L., Kirkevold, M. and Engedal, K. 2012. How do persons with dementia participate in decision making related to health and daily care? A multi-case study. BMC Health Services Research, 12, 241.CrossRefGoogle Scholar
Speare, A. and Meyer, J. W. 1988. Types of elderly residential mobility and their determinants. Journal of Gerontology, 43, 3, S74–81.CrossRefGoogle ScholarPubMed
Strauss, A. and Corbin, J. 1998. Basics of Qualitative Research Techniques and Procedures for Developing Grounded Theory. Second edition, Sage, London.Google Scholar
Taylor-Gooby, P. 2008. Choice and values: individualised rational action and social goals. Journal of Social Policy, 37, 2, 167–85.CrossRefGoogle Scholar
Tilly, J., Wiener, J. M. and Cuellar, A. E. 2000. Consumer-directed home- and community-based services programs in 5 countries: policy issues for older people and government. Generations, 24, 3, 7483.Google Scholar
Tracy, J. P. and DeYoung, S. 2004. Moving to an assisted living facility: exploring the transitional experience of elderly individuals. Journal of Gerontological Nursing, 30, 10, 2633.CrossRefGoogle Scholar
Tyrrell, J., Genin, N. and Myslinski, M. 2006. Freedom of choice and decision-making in health and social care: views of older patients with early-stage dementia and their carers. Dementia, 5, 4, 479502.CrossRefGoogle Scholar
Wada, Y. 2016. Older people's exercising of choice in long-term care: a comparative analysis of England and Japan. Ageing & Society, 36, 6, 1185–210.CrossRefGoogle Scholar
Walker, R., Johns, J. and Halliday, D. 2015. How older people cope with frailty within the context of transition care in Australia: implications for improving service delivery. Health & Social Care in the Community, 23, 2, 216–24.CrossRefGoogle ScholarPubMed
Wang, Y. and Nolan, M. 2016. Older people and decision-making following acute stroke in China: ‘hiding’ as a barrier to active involvement. Ageing & Society, 36, 7, 1526–54.CrossRefGoogle Scholar
Welsh Government 2017. Our Housing AGEenda: Meeting the Aspirations of Older People in Wales. A Report by the Expert Group on Housing an Ageing Population in Wales. Available online at [Accessed 23 February 2017].Google Scholar
Wiener, J. M., Anderson, W. L. and Khatutsky, G. 2007. Are consumer-directed home care beneficiaries satisfied? Evidence from Washington State. The Gerontologist, 47, 6, 763–74.CrossRefGoogle ScholarPubMed
Wilson, S. A. 1997. The transition to nursing home life: a comparison of planned and unplanned admissions. Journal of Advanced Nursing, 26, 5, 864–71.CrossRefGoogle ScholarPubMed
Wittek, R., Snijders, T. and Nee, V. (eds) 2013. Handbook of Rational Choice Social Research. Stanford Social Sciences, Palo Alto, California.Google Scholar
Yeandle, S., Kröger, T. and Cass, B. 2012. Voice and choice for users and carers? Developments in patterns of care for older people in Australia, England and Finland. Journal of European Social Policy, 22, 4, 432–45.CrossRefGoogle Scholar

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