Some limits and political implications of participation within health and social care for older adults

Abstract

This paper critically examines service user participation and involvement for older adults. It concentrates upon research and community-led engagement for older people, and maintains that despite extensive support and expansion, participation offers a complex form of governance and ideological control, as well as a means by which local governments and some welfare professions seek to legitimise or extend their activities. Some of the paradoxes of participation are discussed, including tensions that persist between rhetorical claims of empowerment, active citizenship and democratic engagement on one hand, despite tendencies towards risk-aversion, welfare retrenchment and participant ambivalence on the other. The paper also highlights practical problems in relation to participative research and community involvement, and questions arguments that participation may challenge the authority of welfare professionals. Critical theory is drawn upon to contextualise the role of participative narratives within wider welfare, including its role in moving debate away from ownership or redistribution while masking and validating policy related goals which can counter many older people’s needs. Tension is also noted between participation projects represented as resource to support ageing identities as opposed to those representing technologies for social regulation and conformity.