Background Taking the needs, wishes and experiential knowledge of clients into account is considered to result in a better fit between the supply and demand of modern health care, contributing to the improvement of individual care, organizations, institutions and policy. However, the current generation of the elderly have had little experience of consumer‐oriented public services. They are said to be less likely to discuss their needs and wishes with individual caregivers and health‐care organisations. As a result, they might not receive care matching their needs and wishes. Aim To examine how the elderly themselves refer to their age and their needs and wishes for individual and collective participation in home‐based care to get a better understanding of their participation in their own health care. Methods Content analysis of 20 semi‐structured in‐depth interviews with elderly recipients of care in the Netherlands. Results The need and ability of the elderly to discuss their experiences are strongly affected by physical and mental limitations, social cultural characteristics and their experiences of life. As a result, the elderly encounter many limitations in discussing their experiences with their individual caregivers and their home‐care organisation. However, this does not mean that the elderly do not have needs and wishes that they want taken into account. Conclusion The challenge is to create a more responsive environment and to find new, creative ways of facilitating the expression of the needs and wishes of the elderly, according to the specific values and norms of their generation.