Dimensions of choice in the assessment and care management process: The views of older people, carers and care managers

The aim of promoting the maximum possible choice for service users and carers is – together with the goal of greater independence – central to recent community care policies. This paper sets out a typology of those key choices which users and carers are expected to be able to make within each stage of the assessment and care management process: choices about what services, when to receive them (i.e. at what times and for what duration) and from whom (i.e. which provider organization and which individual care worker). Drawing on interviews with 28 older service users, 20 informal carers and 22 care managers across four local authority areas in England, the paper goes on to describe the extent to which such choices – both at the strategic/macro and operation/micro level – have increased or decreased in practice. The evidence confirms that of other recent studies that the gap between the ‘ideal’ of user and carer involvement and the ‘reality’ of everyday practice is still considerable.