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Research
An exploration of ‘choice’ in relation to social care for older people in a rural area

Social care is currently undergoing a transformation, driven by government policy, and key to this transformation is giving greater choice to service users. This vision of choice is based on a market model of competing service providers; such a model can be difficult to implement in rural areas where problems of space, time and access hamper service delivery. This raises the question of whether policy is biased towards urban areas and highlights the important role that geographical gerontology can play in developing more person-centred social care policy and practice.

This consumerist vision of social care has also fuelled a theoretical debate which underpins this research. The market model of choice has been located within a wider discourse which regards the self as a rational, self sufficient individual. An alternative discourse has been posited from a feminist ontology in which interdependence and co-responsibility come to the fore; such a discourse emphasises the personal dimension to social care practice. This project forms the research component of a professional doctorate in occupational therapy and is concerned with the self-expressed views of rural older people in relation to the above social care theory and policy.

Taking a phenomenological approach, a narrative methodology was used to interview 11 older people who live in either a village or isolated location in West Northumberland. Three respondents chose to have a carer present and participate in the interview. Purposeful sampling was used and access to the participants was established via care managers from Northumberland Care Trust, with ethical approval secured prior to commencement from the regional NHS Ethics service. Interviews were all tape recorded, conducted in participants’ own homes and an interview guide was used to keep the conversation focused on research aims.

Transcribed interviews were read and re-read as openly as possible to draw up a provisional thematic framework; which comprised key concepts in the areas of ‘sense of place’, ‘meaning of choice’ and ‘social care experience’. This was then applied systematically to all of the data so that all of the text was coded.

Preliminary findings suggest participants do have a strong attachment to their local environment which is articulated in a sense of familiarity and continuity. The narratives around social care re-affirm findings from previous research which assert low expectations, self sufficiency and the crucial role of human relationships. At a superficial level, ‘choice’ is not a term the participants relate to social care; though they appeared to make choices on a daily basis both in relation to social care and their home situation. The next stage of the research will explore these concepts in more depth; developing theory about the construction of interpretations and factors that influence this construction. Finally, the main themes will be related to existing theory in the areas of social care and geographical gerontology to develop an original contribution at the interface of these two domains.

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