Voice and choice for users and carers? developments in patterns of care for older people in Australia, England and Finland

This article identifies key trends over the last 20 years in residential and community care for older people in England, Finland and Australia, investigating the extent of ‘de-institutionalisation’, ‘privatisation’ and ‘individualisation’. The concepts of collective and individual ‘voice’ and ‘choice’ are used to interrogate the roles of collective and individual actors, older people and carers, in influencing policy formulation. While these three processes have been pursued by policy-makers in each country, their implementation is illuminated by understanding how ‘voice’ and ‘choice’ have been operationalised – individually and collectively – in each context. In the reshaping of eldercare in the three states, the analysis identifies the greater influence of claims-making by family carers, who provide the informal bastion of formal care services in the push to de-institutionalisation, in comparison with the collective and individual voices of older people as ‘service users’.