Introduction

The current trend in many European countries is shifting caring responsibilities towards the individual and promoting independence among older people. In this chapter it is argued that older people who need long-term care are most likely to be physically/mentally frail and they are more likely to be involved with multiple care actors. It for this reason that the power and autonomy of dependent older people is essential to ensure their quality of care is maintained. However, it also means that securing the autonomy of dependent older people within the complexities of the long-term care system remains a challenge. This chapter seeks to explore some solutions. It focuses on the entire long-term care framework and uses international comparisons to understand the range of policy options in order to learn from the successes (or failures) of foreign care systems. The countries selected – England, the Netherlands and Taiwan – were chosen because each represents a different welfare arrangement. In addition, many eastern countries such as Taiwan share with the West a similar trend of an ageing society (UN, 2001).

The chapter first covers theoretical views on power and autonomy as well as the care systems of older people in the three countries. It is concerned with issues of autonomy, globalisation, welfare typologies, needs, social inclusion and empowerment; the outcomes of autonomy are not purely ethical issues but consist of characteristics among the welfare systems, such as cultural beliefs and practical issues. The chapter then focuses on empirical research to offer an in-depth exploration of the conception of autonomy among the three care systems. It highlights older people's experiences of social and personal barriers that are inhibiting them from becoming more active socially and politically while in care. It also seeks to understand how their experiences of autonomy have affected their care and well-being. The concluding section draws together practical issues and offers signposts for cross-national learning.

Background perspective

Theories and policies in promoting autonomy in the long-term care of older people

In the context of long-term care, autonomy is crucial in determining quality of life and ensuring that older people are to be in control of their care (Österle, 2001; Boyle, 2003). The conventional view of autonomy comes from liberal bioethical thought associated with prioritising self-capability of independence, non-interference, self-determination, self-reliance and choice.