Policy makers, practitioners and academics often claim that care users and other citizens should be ‘at the center’ of care integration pursuits. Nonetheless, the field of integrated care tends to approach these constituents as passive recipients of professional and managerial efforts. This paper critically reflects on this discrepancy, which, it contend, indicates both a key objective and an ongoing challenge of care integration;  the need to reconcile the professional, organizational and institutional frameworks by which care work is structured with  the diversity and diffuseness that is inherent to pursuits of active user and citizen participation.