Autonomy and risk: the role of client wishes in community-based long-term care.

This study examines the extent to which a client's choices are incorporated in care decisions within a prepaid, community-based long-term care program. Decision criteria used by the program's case management team regarding client autonomy included indicators of risk to client stability and of limits on organizational resource capacity. Under certain "high-risk" conditions, self-determination could decrease in importance in light of the care needs of the program's total client population.