Autonomy for elderly people in long-term care.

A cross-sectional view of the extent to which residents in long-term care exercise autonomy has been obtained from an audit using the Royal College of Physicians' CARE scheme (Continuous Assessment Review and Evaluation) in 17 long-term care facilities among 298 residents. Most centres have procedures in place to enable residents to exercise choice, on information or services provided and how to complain, but only half provide opportunities to comment on policy and procedures and planned changes. There was a high level of personal care plans but many of these were disappointing in their detailed content; less than half of the residents had a key worker; a series of indicators of choice scored reasonably high in nursing homes but lower in hospitals; independent advocates are in evidence where patients' mental competence is in question. The established use of care plans should provide a foundation for improvements in this aspect of the quality of care. Such audits could form the basis for a national quality system in long-term care.