Care or Control: Barriers to Service Use by Elderly People

Abstract

This article presents descriptive findings from a 3-year project that examined barriers to receiving effective health care service from the viewpoint of elderly people living in an inner city. The convenience sample consists of 38 elderly people identified by clinicians providing hospital and community care as at risk of institutionalization. Based on the elderly persons' descriptions of their problems, these clinicians developed innovative strategies for making the service delivery system more responsive. Individual situations were reviewed retrospectively to identify trends in the types of barriers to effective service delivery. McKnight's paradigm, contrasting human interactions in a control model to those where participation occurs by consent, was found useful in conceptualizing barriers to effective care, as exemplified by these individual situations Previous care, which the elderly people perceived as controlling, contrasted sharply with their expectations for full participation in the definition of both problems and solutions. Thus clmical practice and the research focus of the project evolved to offer elderly people assistance in ways that facilitated their full participation.