Elders' decision making regarding the use of long-term care services: a precarious balance

The purpose of this qualitative study was to explore factors that influenced decision making regarding the use and nonuse of long-term care services, with a particular focus on elders' attitudes, values, and beliefs. The sample (N = 27) consisted of high-functional elders recently admitted to nursing homes and community-dwelling, high-risk elders recently diverted from nursing homes following a prescreening program. Data were collected through indepth, face-to-face, semistructured interviews and analyzed using qualitative content analysis. Independence and sense of self were the strongest values to emerge. The attitude of acceptance, both passive and active, helped elders cope with increasing levels of dependency and lifestyle changes. The desire to be part of decisions, both major life planning and day-to-day choices such as meal planning, was pervasive. Decision making was individualistic and complex. Loss of control was threatening to the sense of self, leaving some elders feeling shortchanged.