Decision-Making Among Street-Level Bureaucrats in Residential Care for Older Adults: A Scoping Review

This scoping review synthesizes evidence on discretionary decision-making by street-level bureaucrats in residential care for older adults and its implications for care quality and residents' well-being. Following the PRISMA-ScR framework, 12 studies published between 2019 and 2024 were reviewed. Four themes emerged: resident autonomy, shared decision-making, ethical and relational practices, and organizational factors. Findings highlight variability in discretionary practices shaped by organizational cultures, resource constraints, and differing interpretations of autonomy. The review underscores the need for supportive policies, adequate staffing, professional training, and organizational environments that promote transparent, participatory, and person-centred decision-making.