Abstract
In the article the participation of the aged users and their relatives in a local health care and social service system will be discussed. How is their citizenship defined at the grass roots level? The research data were gathered during a case management project of the action research type in a Finnish rural municipality. The data of this study consist of 13 theme interviews: five elderly persons as care receivers and eight caregivers. The research approach is a dialogue between data based analysis and conceptual reasoning. Citizenship rights and obligations and participation should be defined flexibly and individually in the context of the local health care and social services. In the research data the elderly persons and their caregivers described participation in multiple ways. The modes of participation vary from passive and active disengagement from the process to contacting, negotiating, cooperating, and demanding
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