Transition and choice in residential long-term care for older people in England

Care transition, the process of moving from community care to residential care, is one of the biggest changes that older people can experience in their later life. Evidence from the literature suggests that older people's experiences of care transition tend to be negative and traumatic, with most of them being little involved in the process of care transition.
How older people exercise choice during the period of care transition is important for understanding their experiences of care transition for the following two reasons: first, choice has been referred to in the literature as the key to less stressful care transition experiences, which can subsequently lead to a better quality of life in residential homes; second, the introduction of choice in public services has been the key plank of British social policy in recent decades and there has been a movement towards extending choice in residential care.
This research aims to study older people's care transition experiences and their exercise of choice during the process of care transition, to explore the meaning and the perceived effects of choice and to identify the role of choice in promoting a positive care transition.
This thesis presents findings from 48 in-depth interviews with older people who became new residents in one of the ten participating residential homes in London and had their care paid for by the local authority. This research identified four groups of older people who showed marked differences in terms of their needs, their exercise of choice during the care transition process and their adaptation to residential care: Active Planners, Conformists, the Unsettled and Shelter-Seekers.
The findings from this research suggest that the older people's care transition experiences varied and that they stretch beyond the prevailing evidence emphasising the stressfulness of the care transition. The cases of Active Planners and Shelter-Seekers show the potential for positive roles for care homes in the case of users with genuine needs for residential care. An overwhelming majority of the older people who were interviewed were great proponents of choice and many of them actively exercised choice in the course of their care transition. This challenges the claim of the passivity of older people which has been argued in the literature. However, the cases of some Conformists who did not want to exercise choice also highlight that having no choice can be a choice for some older people. On the whole, older people’s exercise of choice played an important role in facilitating a positive transition, despite it not being a precondition for such a transition. However, there were administrative issues limiting the level and the extent of choice that were available to the older people and the Unsettled experienced an undesired move into a care home, having their choices denied or rejected. This thesis also questions the working of choice and competition in residential care, as the older people did not seem to enjoy the expected benefits of choice relating to service improvements which have been argued for in the literature.

Keywords: residential care
care transition
ageing
long-term care
user choice
older people
social care
Advisor: Kemp, P