The importance of service-user participation has been growing in the care services, but what possibilities do service users have to influence these services? This article analyses how structural factors have an impact on the scope of possibilities for user influence in care services, especially with respect to how established structures and frameworks determine users’ opportunities to influence both the allocation and the provision of services. A study of five Norwegian municipalities where managers at different levels and within different areas of the services have been interviewed forms the basis of the empirical material. In the managers’ general opinion, over time there has been a stronger individual adjustment of the services and stronger user influence over both the allocation and the provision of services. However, if we look more closely at the service-delivery process, several structural factors limiting the scope of possibilities for user influence become apparent. These factors are discussed in light of different user typologies.

Growing demand for beds in government-subsidized long-term care (LTC) homes in Ontario is causing long waitlists, which must be absorbed by other residential alternatives, including unsubsidized retirement homes. This study compares Ontario’s LTC homes and retirement homes for care services provided, funding regimes, and implications of differential funding for seniors. Descriptive data for both types of homes were collected from public and proprietary sources regarding service offerings, availability, costs, and funding. Overlaps exist in the services of both LTC and retirement homes, particularly at higher levels of care. Although both sectors charge residents for accommodation, most care costs in LTC homes are publicly funded, whereas residents in retirement homes generally cover these expenses personally. Given waitlists in Ontario’s LTC homes, many seniors must find residential care elsewhere, including in retirement homes. Several policy alternatives exist that may serve to improve equity of access to seniors’ residential care.

This study explores policy makers’, health-care professionals’ and senior volunteers’ perceptions of senior volunteers. Two Norwegian government white papers regarding older adult care and welfare services, which were published over a period of 19 years, were selected for close examination. Furthermore, focus group interviews with a purposeful sample of five senior volunteers and 15 health-care professionals were conducted. The study explores the discursive formations of senior volunteers in the government white papers and how they are negotiated in the senior volunteers’ and the health-care professionals’ narratives. Two dominant discourses were presented in the white papers: a prevention discourse (in which volunteering was presented primarily as a means to prevent volunteers’ loneliness and need for care services) and a sustainability discourse (in which the volunteers were presented as instrumental in future sustainable care services). Both discourses echo a common overarching discourse about a capacity crisis due to the ageing population. The senior volunteers were positioned as partners and active agents in both their own narratives and the health-care professionals’ narratives. Their position as independent and as spokespersons for the less empowered were evident only in the senior volunteers’ own narratives. Only the health-care professionals referenced the prevention discourse and capacity issues. The senior volunteers presented themselves as competent, efficient political actors, and they resisted both the prevention and sustainability discourses. In the senior volunteers’ narratives, social and political participation were interrelated. The study demonstrates that new discursive landscapes must be created to capture the diversity among senior volunteers and their efforts. While senior volunteers must be meaningfully involved in decision making, planning and design, their positions as independent and active agents must also be ensured. Authentic partnerships between senior volunteers and public care services involve a balance between involvement and independence.

This article reviews the consultation process during the development of a local dementia strategy. The processes of involvement by the range of stakeholders involved and how their different views shaped the strategy are considered. Particular attention is paid to the involvement of people with dementia as they are the recipients of the services to be shaped by the strategy and also form the group most difficult to reach. This article demonstrates the value of including a wide range of stakeholders in the development of local policy and the importance of involving people with dementia in policy development.