Today, most elderly people with disabilities receive help at home, and 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 first major Norwegian study of control over everyday life among the elderly, on the other hand, 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."

Lisa Victoria Burrell, The Norwegian University of Science and Technology

Burrell is a researcher at the Centre for Care Research at the Norwegian University of Science and Technology (NTNU) Gjøvik.

Less control and meaningful activity

Researchers at the center have 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 have also spoken to relatives and staff. And observations have been 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.

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 poorer 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. It provides good physical and cognitive health, prevents frailty, reduces mortality, increases quality of life and promotes good health choices.

"It is therefore a major problem that many elderly people who receive home care services feel they have a lack of control over their everyday lives," says Burrell.

Unpredictable home care visits

Burrell believes that one explanation is that the everyday life of the elderly is all about change. They have to transition from managing things on their own to being dependent on help. Now, control means being informed, listened to, respected and included in decisions about their own lives. How care is provided and who provides the care thus determines their experience of control over their everyday lives. This kind of control also needs to be created when the elderly interact wit the 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 that there is a lot of employee turnover, so that the home care providers are often unknown to their elderly clients.

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 said.

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.

"And then politicians and health authorities must 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," Burrell said.

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 increase continuity with respect to the workers who visit the homes of the most frail.