Quick answer: Older people can be in control of decision making about their care and support needs when they are given clear information, offered real choices, supported to communicate their wishes, and treated as the expert on their own life. This means using a person-centred approach, respecting their rights under the Care Act 2014 and Mental Capacity Act 2005, involving advocates where needed, and keeping care plans flexible and regularly reviewed.
What Does Being “In Control” Actually Mean?
Being in control of decision making does not mean the older person makes every decision alone or without advice. It means:
- They are involved in every discussion about their care
- They understand the options available to them
- They can express their preferences freely
- Their wishes are recorded and acted on
- They can change their mind at any time
- They are not overruled simply because of their age
Control is about influence, not isolation. An older person may want to make decisions with family, carers or professionals — but the final say should be theirs wherever they have capacity.
The Legal Rights Behind This
Older people have specific legal rights that protect their control over care decisions.
| Law | What it protects |
| Care Act 2014 | Wellbeing principle; person-centred care; right to be involved in assessments and care planning |
| Mental Capacity Act 2005 | Presumption of capacity; right to make unwise decisions; least restrictive option |
| Human Rights Act 1998 | Article 8 — right to respect for private and family life |
| Equality Act 2010 | Protection from discrimination based on age or disability |
| CQC Regulation 9 | Person-centred care that meets individual needs and preferences |
| NHS Constitution | Right to be involved in decisions about your own care |
These laws mean that older people cannot simply be told what will happen to them. They must be asked, informed and involved.
How Older People Can Be in Control — Practical Ways
1. Person-Centred Care
Person-centred care puts the older person at the centre of every decision. It recognises their life history, culture, beliefs, health needs and personal tastes.
How workers support this:
- Listen closely to what the person wants
- Allow unhurried time for them to express themselves
- Offer a genuine range of choices, not just one option
- Respect decisions even when they differ from professional opinion
This approach helps older people feel valued and in charge of their own support.
2. Clear Communication
Many older people have hearing loss, sight problems, memory changes or speech difficulties. Workers must adapt how they communicate so the person can fully take part.
Ways to support communication:
- Use plain, simple language without jargon
- Speak slowly and allow time for responses
- Check understanding by asking the person to repeat information back
- Provide written information in large font
- Use pictures, diagrams or easy-read formats
- Arrange an interpreter if English is not their first language
Good communication is the foundation of real choice.
3. Independent Advocacy
An advocate speaks on behalf of a person who finds it hard to express their views. This may be due to cognitive impairment, low confidence, or communication difficulties.
Types of advocacy:
- Family or friends — informal support
- Trained volunteers — community advocacy schemes
- Independent Mental Capacity Advocates (IMCAs) — legally required in certain decisions
- Independent Care Act Advocates — for Care Act assessments
An advocate makes sure the older person’s voice influences the care plan, rather than decisions being made over their head.
4. Shared Decision Making
Shared decision making means the older person and professionals discuss options together. The professional explains risks, benefits and practical factors. The older person describes their priorities, lifestyle and comfort levels. Together they agree the best option.
Examples:
- Choosing between home care visits or moving to supported living
- Selecting the timing and length of care visits
- Deciding which daily tasks they want help with
- Choosing which family member to involve
This approach respects the older person’s knowledge of their own life.
5. Involving Family and Friends — Properly
Family and friends can support decision making by:
- Reminding the person of previous choices
- Explaining information in a familiar way
- Attending meetings for emotional support
- Helping with practical arrangements
However, workers must make sure family influence does not replace the older person’s voice. Always check that the final decision reflects what the older person wants — not what the family prefers.
6. Respecting Autonomy
Autonomy means self-rule — the right to control your own life. In care, respecting autonomy means:
- Never making decisions for someone without their input
- Asking permission before any action
- Offering options and letting the person choose
- Supporting them to live by their own values
Workers must not assume an older person cannot decide for themselves. Under the Mental Capacity Act 2005, capacity is presumed unless there is clear evidence otherwise.
7. Using Care Plans as a Tool for Control
A care plan is a written record of the person’s needs, wishes, schedules and agreed actions. When older people help create and review it, they gain direct control over their support.
They can:
- Approve or change the plan before it starts
- Request new services or decline ones they do not want
- Choose the order tasks are carried out
- Review and update the plan regularly
Keeping the plan flexible means the older person stays in control even as their needs change.
8. Supporting Capacity
The Mental Capacity Act 2005 explains how to support someone to make decisions, and when decisions can be made on their behalf. It says:
- Assume the person has capacity unless proven otherwise
- Take all reasonable steps to help them decide
- Do not treat an unwise decision as proof of lacking capacity
Support steps include:
- Giving information in more than one form
- Holding meetings in quiet, comfortable places
- Choosing times when the person is most alert
- Allowing breaks during long discussions
If the person is assessed as lacking capacity for a specific decision, it must be made in their best interests, involving family or advocates.
9. Use of Technology
Technology can help older people stay in control of their care. Examples include:
- Video calls with health professionals
- Medication reminders on a phone or tablet
- Online portals to view and comment on care plans
- Smart home devices for safety and independence
Workers should offer training at a comfortable pace and make sure devices are accessible — for example, larger text or voice controls.
10. Choice in Daily Living
Control over daily life is just as important as big decisions. Workers should encourage older people to decide:
- Meal times and food preferences
- Clothes for comfort or personal style
- Activities and hobbies
- Whether visits happen in the morning or evening
- Who they spend time with
These small daily choices build a sense of respect, value and independence.
11. Cultural and Religious Preferences
Older people may want care that respects their culture or religion. This can include:
- Food preparation and dietary rules
- Clothing and personal routines
- Prayer times and religious services
- Gender preferences for personal care
Workers must ask about and record these preferences, then make sure they are followed. This keeps care meaningful and gives the person control over important parts of their identity.
12. Managing Risks Together
Sometimes older people choose options that carry more risk — such as living alone despite mobility issues. Workers must balance safety with the person’s right to decide.
This means:
- Explaining the risks clearly
- Discussing ways to reduce them
- Not removing independence in the name of safety
Practical solutions include grab rails, emergency alarms, regular phone check-ins, or a care visit at a key time of day.
13. Feedback and Reviews
Regular reviews give older people the chance to adjust their care. Meetings should be:
- Held in a comfortable, accessible place
- Conducted at a time that suits the person
- Supported by advocates or family if wanted
Feedback can be gathered through conversation, forms or anonymous suggestions. Any changes should be recorded in the care plan and acted on promptly.
14. Preparing for Changes
Older people may face changes in health, home environment or family support. Involving them early in planning helps them stay in control.
Discussions can cover:
- Possible future care settings
- How to keep contact with loved ones
- Preferred routines if health declines
This reduces anxiety and keeps the person’s voice at the centre during transitions.
15. Building Trust
For older people to take control, they must trust the workers and organisations supporting them. Trust grows when workers:
- Follow through on promises
- Respect confidentiality
- Treat the person consistently with kindness
- Admit mistakes and correct them
A good relationship makes it easier for the person to speak openly about their needs and preferences.
16. Training for Workers
Workers can improve their skills in involving older people through training in:
- Communication techniques
- Person-centred practice
- Mental Capacity Act and Care Act duties
- Advocacy and safeguarding
A well-trained worker can balance professional knowledge with respect for the person’s right to choose.
17. Supporting Emotional Wellbeing
Taking control of decisions improves emotional wellbeing. It reduces helplessness and builds confidence.
Workers can:
- Encourage older people to state preferences openly
- Reassure them that their opinions matter
- Acknowledge their lifetime of experience
- Celebrate when their choices are acted on
When people feel heard, they engage more positively with their care.
A Person-Centred Example (Use This in Your Diploma)
Scenario: Mr Okafor, 79, has early-stage Parkinson’s and receives home care. He wants to reduce his morning visits because he prefers to get up slowly and independently.
How he stays in control:
- His care worker asks him what a typical morning looks like for him
- She explains the risks of reducing support and what could be reviewed later
- Mr Okafor decides to keep a shorter visit three times a week
- The care plan is updated with his new schedule and signed by him
- A review is booked for four weeks
- His daughter is informed with his consent
Outcome: Mr Okafor feels respected and independent. The care team monitors his safety. His care is shaped by his choices, not by assumptions about his age or condition.
Common Mistakes to Avoid
- Assuming an older person cannot decide because of their age
- Letting family make decisions without checking the person’s wishes
- Offering only one option and calling it “choice”
- Using jargon that the person does not understand
- Writing care plans without the person’s input
- Treating an unwise decision as proof of lacking capacity
- Failing to review the care plan regularly
- Ignoring cultural or religious preferences
Key Takeaways for Your Diploma
- Being in control means being informed, involved and heard — not deciding alone
- The Care Act 2014 and Mental Capacity Act 2005 are the legal backbone
- Person-centred care, clear communication and advocacy are the main tools
- Care plans should be written with the person, not for them
- Capacity is presumed — never assume someone cannot decide because of age
- Small daily choices matter just as much as big decisions
- Always document the person’s wishes, decisions and reviews
Frequently Asked Questions
It means they are fully involved in discussions, understand their options, can express their preferences freely, and their wishes are recorded and acted on — regardless of their age.
The Care Act 2014, the Mental Capacity Act 2005, the Human Rights Act 1998, the Equality Act 2010, and CQC Regulation 9 all protect the right of older people to be involved in decisions about their care.
By using plain language, speaking slowly, providing written or visual information, checking understanding, and arranging an interpreter or advocate if needed.
Shared decision making means the person and professionals discuss options and agree together. Making a decision for someone only happens when they have been assessed as lacking capacity for that specific decision, and it must be in their best interests.
An advocate speaks on behalf of the person to make sure their views and preferences influence care planning. Independent advocates, including IMCAs, are legally required in some situations.
Care plans record the person’s needs, wishes and agreed support. When the person helps create and review them, they keep direct control over how their care is delivered.
Under the Mental Capacity Act 2005, adults with capacity have the right to make unwise decisions. Workers should explain the risks, discuss ways to reduce them, and respect the person’s decision.