Opening up Options: Decision Making Around Older People's Assets

Historically, social work has been aligned with those in society who are vulnerable or are dangerous to others. The ideal, if not always the reality, for the profession is to ensure that their views are heard and acted upon. We often struggle to strike a balance between promoting people’s autonomy and keeping them safe, or keeping others safe from them. In resolving such struggles we may well restrict, rather than open up options, particularly when those we are concerned with are not particularly valued by society. Our research (Tilse, Wilson, & Setterlund, 2003; Tilse, Setterlund, Wilson, & Rosenman, 2005) over a number of years has focused on older people and their financial assets, a project initially motivated by an awareness that, for many older people, the increasing deficits associated with ageing provided an avenue for others to be involved in their assets. A concern was that this involvement could provide an opportunity to exercise control over both the older people and their assets. We have concluded that a key concern for social work in relation to these issues is a focus on facilitating decision making that offers older people as much autonomy as they want or can express. There are three broad overlapping approaches to decision making with decreasing levels of control by the older person: self-determination, supported decision making, and substitute decision making. Hopefully, social work is focused on opening up options, and achieving the least restrictive option in all three approaches. We may want to achieve increased autonomy for older people but we might prioritise safety or managing risk over autonomy, thereby reducing options and increasing oversight. We are working in a rapidly changing service environment. Enhancing the exercise of individual choice and control in decisions about care is the cornerstone of contemporary disability policy and increasingly of aged care in the community. Packaging care so that individuals can make decisions about how their care dollars are spent drives this agenda. Services funded in this way are targeted to the needs of individuals who qualify for a “package” of care. However, the National Disability Insurance Scheme and aged care packages are not designed to meet all needs and nor will all people with care needs in these categories receive packages. It is in mainstream services that social workers will make their major contribution to both groups in ensuring they have appropriate choice and control over decisions that affect their welfare. Decisions around the use of assets for older people may centre on making resources last, or on the complexity of decisions, particularly in relation to negotiating entry into residential care, or on enacting moral or cultural duties such as deciding how much should or could be left as an inheritance or to assist younger generations. Such decisions often take place in a context where there are other people who wish to use the assets of this group. Our program of research has suggested there are three patterns of providing Australian Social Work, 2015 Vol. 68, No. 2, 153–155, http://dx.doi.org/10.1080/0312407X.2015.1010555