Resident decision-making in the context of residential aged care

Background: Worldwide research confirms that older people value autonomy, want to remain independent and want control over their lives for as long as possible. Accordingly, the aged care system in Australia is undergoing major government-initiated reforms and is moving towards consumer directed care. Aim: To explore the views of residents and care staff of resident decision-making, choice and control in the residential aged care context. Methods: Residents from across four residential aged care facilities in Adelaide were interviewed and staff focus groups were held. A thematic analysis of the data was conducted. Findings: Residents valued opportunities for privacy, communal engagement, productivity, negotiation with staff, and for opportunities to engage with systems of governance. How staff prioritise resident decision-making is influenced by the carer's judgement of the resident's characteristics and of the organisation's rules and polices. Discussion: Older people living in residential care are no longer living in their own home but instead are dealing with organisational rules and routines framed by others upon whom they are dependent. Conclusion: The day-to-day decision-making process for residents is likely to remain complex due to residents having to take into account rules, regulations and policies operationalized through organisational channels.