Agency in later life: The unrecognised operatrices of a fragmented care system

Contrasting predominant assumptions of women who live with age-related care needs as passive, unagentic, and helpless, this article explores agency exercised in everyday lives permeated by formal home care services. Using a narrative thematic analysis of interviews, diaries, and observations of three Swedish women in later life using home care services, this study examines their diverse ways of navigating and managing a care system that can be described as complex and fragmented. As users of domiciliary care, they lead, instruct, and educate staff; they prepare for and assist in carrying out service provision, coordinate service agents, and engage empathetically with staff to reduce stress levels. At times, they also protest, resist and criticise, or express contentment in spite of questionable service quality. The analysis conceptualises such manifestations of agency as a regime-dependent, situationally embedded striving to influence everyday life, encompassing not only overt, goal-directed actions but also seemingly passive or contradictory orientations such as withdrawal, acceptance, refusal, or even self-harming practices. The findings demonstrate how the participants - Betty, Ofelia, and Gunnel - each enact distinctive approaches: Betty pragmatically seeks to tailor services to her preferences, Ofelia critically challenges and attempts to influence the system, and Gunnel strives to maintain harmony through collaboration. Their extensive engagement contests assumptions that women in the so-called 'fourth age' have lost their agency. Instead, the study shows that, in becoming operatrices of the care system, they paradoxically uphold or even intensify their agency, which calls for recognising care users' influence over the services they rely on.