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Elderly people living at home have less control, not more
Elderly Norwegians are encouraged to remain at home where they can receive home care services, supposedly giving them more control over daily life. Research suggests the opposite is true.
Published
Today, most elderly Norwegians with disabilities receive help at home. There are limited places in nursing homes.
At the same time, politicians claim that living at home provides independence and control over one’s everyday life.
The new study shows something completely different.
“Those who receive home care services have significantly less control over their everyday lives than those who live in nursing homes or care homes,” says Lisa Victoria Burrell.
She is a researcher at NTNU's Centre for Care Research.
What do the patients think about their quality of life?
Researchers at the centre interviewed 414 elderly users in three municipalities in Eastern Norway. The participants live in nursing homes, in care homes, or receive home care services.
They also spoke to relatives and staff. And observations were made of residents of nursing homes and care homes with cognitive impairment.
“We wanted to look at these questions: How are the patients really doing? What do they think about their quality of life, and how much do they feel they have control over their everyday lives?” says Burrell.
Less control and meaningful activity
The results show that:
A third of older people who receive home care services feel they have little or no control over their everyday lives.
Those who receive home care services have significantly less control over their everyday lives than those who live in care homes and nursing homes.
They also experience less meaningful experiences than older people in care homes. In other words, they are more bored.
“The paradox here is that elderly people who receive home care services have the best conditions for experiencing control. They are younger, are healthier mentally and physically, and have more contact with family and friends, than those who live in care homes and nursing homes,” says Burrell.
Being in control has many advantages
According to Burrell, being in control is associated with good physical and cognitive health, prevents frailty, reduces mortality, increases quality of life, and promotes good health choices.
“It's therefore a major problem that many elderly people who receive home care services feel they have a lack of control over their everyday lives,” she says.
Burrell believes one explanation is that older people face many changes in everyday life.
Unpredictable home care visits
They have to transition from managing things on their own to being dependent on help.
Control now means being informed, listened to, respected, and included in decisions about their own lives. How care is provided and who provides the care therefore determines their experience of control over their everyday lives.
This kind of control also needs to be created when the elderly interact with home care services.
“Here, the home care service can be a barrier to perceived control. Many elderly people living at home are frustrated by long waiting times and unpredictable visits from the home care services. Their daily routines and meaningful activities are at the mercy of the employees’ schedules,” says Burrell.
Another factor is high staff turnover, meaning elderly clients often receive home care from providers that are unfamiliar to them.
But many elderly people want to live at home anyway
Many elderly people want to live at home for as long as possible.
They are afraid of losing control and independence if they move to a nursing home. Lisa Burell says the opposite is likely to be true.
“Elderly people in nursing homes experience more control than those living at home,” she says.
But not everyone can live in a nursing home. The municipalities cannot afford that.
If older people are to thrive at home, they must feel that they control and have mastery over everyday life, Burrell explains.
“And then politicians and health authorities need to stop highlighting home care services as an offering that gives seniors good control and that contributes to their independence. Instead, the authorities need to take measures to achieve this goal,” she says.
Four things in particular need to be in place
The employees must be given enough time to do their job in a caring way.
The home care service must include users in decisions, listen to their opinions, and try to comply with their wishes.
Elderly people must be treated with respect and consideration by the staff and by the municipality.
The municipality must ensure that the most frail receive care from the same workers more consistently.
Reference:
Burrell et al. Individual and interpersonal factors associated with care-related quality of life in older adults: a comparison of home-based services, nursing homes and sheltered housing, Age and Ageing, 2026. DOI: 10.1093/ageing/afag039
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