Support For Older People Research Articles

Supporting older people with cognitive impairment during and after hospital stays with intersectoral care management (intersec-CM)-results of a randomised clinical trial.

The transition from hospital to primary care is a risk factor for negative health outcomes in people with cognitive impairment. To test the effectiveness of intersectoral care management during the transition from hospital to primary care on repeated admission to hospital, functionality and institutionalisation in people with cognitive impairment. Longitudinal multisite randomised controlled trial with two arms (care as usual and intersectoral care management) and two follow-ups 3 and 12months after discharge. Three hospitals in two different primary care regions in Germany. n = 401 people with cognitive impairment: community-dwelling, age 70+. Randomised into control (n = 192) or intervention (n = 209). Primary outcomes for the study after 3months: admission to hospital, physical and instrumental functionality. Primary outcome after 12months: institutionalisation, physical and instrumental functionality. Secondary outcomes: health-related quality of life, depressive symptoms, cognitive status and frailty. Statistical analyses include descriptive analyses as well as univariate and multivariate regression models for all outcomes. There was no statistically significant effect of the intervention on hospital admission and activities of daily living after 3months, as well as on institutionalisation and activities of daily living after 12months. There were significantly fewer participants in the intervention group readmitted to the hospital 12months after discharge.Analyses show a significant effect on health-related quality of life 3months and 12months after discharge. Depressive symptoms were significantly less likely in the intervention group 3months after discharge. No effects on cognition or frailty. Intersectoral care management supports people with cognitive impairment during discharge and transition. Even though we were not able to show an impact of the intervention on the chosen primary outcomes everyday functionality and institutionalisation, the effects on health-related quality of life, hospital admission rate and mental health are solid indicators for an improved individual situation. ClinicalTrials.gov, NCT03359408; https://clinicaltrials.gov/ct2/show/NCT03359408.

A Community-Led Approach to Understanding How Service Providers Can Support ‘Ageing well’ for Older Aboriginal People in Australia

ABSTRACT Supporting older people to age well is a global policy priority, however the development and implementation of strategies to support ageing well for older Aboriginal people must be determined by the communities affected. This is necessary in colonial contexts, where socio-political structures impinge on Aboriginal rights and mainstream policy and practice creates and maintains health and social inequities. This article reports on research conducted in partnership with the Dharriwaa Elders Group, an Aboriginal Community Controlled Organisation. The research focus was how service provision can support Aboriginal people to age well in a remote community in New South Wales, Australia. Interviews were conducted with 11 staff members from health, aged care, and Aboriginal Community Controlled services. The analysis produced four themes: Ageing well is collective and a shared responsibility; Racism and discrimination are pervasive in mainstream services; Intersectional barriers and enablers to ageing in place; Trust and cultural safety are integral to service accessibility. Our discussion explores the cultural and socio-political context of these findings and highlights implications for policy and practice.

Service delivery and the role of clinical pharmacists in UK primary care for older people, including people with dementia: a scoping review

ObjectiveAs populations age globally, there is increasing prevalence of multiple long-term conditions, such as dementia, leading to many challenges. The burden on health and care services, economic pressures, and the necessity for innovative policies to better support older people and people with dementia becomes paramount. This review explores how clinical pharmacists working in UK primary care support older people and people with dementia.DesignScoping review.MethodThis review was conducted following the framework for scoping reviews in accordance with the Joanna Briggs Institute (JBI) methodology. The search of Scopus, EMBASE, CINAHL, Web of Science, PsycINFO, and Cochrane was initially conducted in September 2022, and updated in August 2024. Searches included literature exploring the landscape of clinical pharmacy services for older people in the UK, focusing on roles and services delivered, perceptions, and experiences.ResultsA total of 30 articles were included. These detail the multifaceted responsibilities of clinical pharmacists in primary care for older people. Stakeholder perspectives, including healthcare professionals and patients, emphasised the positive outcomes of clinical pharmacist involvement, from reducing other practitioners’ workloads to improving patient safety. However, communication gaps, concerns about competence from other healthcare professionals, and the need for clear role definitions emerged as challenges. Research focused on the experiences of underserved groups, such as people with dementia or from minority ethnic backgrounds, is lacking.Conclusions and implicationsThe review enhances our understanding of the primary care clinical pharmacist service in the UK and identifies gaps in evidence, emphasising the need for empirical studies on the experiences of older people with cognitive impairment and those from minority ethnic backgrounds. It provides insights into what makes an effective clinical pharmacist service, such as training and communication, which may help to inform international policy and practice and improve service provision globally.

Abuse and its associated factors among elderly population of Kamalamai Municipality of Sindhuli District, Nepal.

The global rise in the elderly population brings attention to the pressing issue of elder abuse, categorized into physical, psychological, neglect, financial and sexual abuse. According to the World Health Organization (2022), one in six individuals aged 60 and older has experienced some form of abuse in community setting necessitating increase in awareness and support for older people. This study aimed to assess abuse and its associated factors among elderly population of Kamalamai Municipality of Sindhuli District, Nepal. We conducted a community-based cross-sectional study utilizing both qualitative and quantitative methods. We collected data from June 15 to September 15, 2023. The study involved 398 elderly participants (≥60 years). Stratified sampling techniques was used to select participants. For the qualitative study we utilized purposive sampling technique which included two key informant interviews, one in-depth interview and two focus group discussions. We analyzed quantitative data using IBM SPSS version 20 applying bivariate and multivariable logistic regression analysis at a 95% confidence interval. For qualitative data, thematic analysis was done. The mean ± SD age of the elderly participants was (70.8± 8.08) years. Among the total of 398 study participants, (64.1%) participants reported experiencing different forms of abuse. The study found that neglect (46.0%), psychological abuse (42.5%), and financial abuse (24.4%) were the most common while physical abuse (4.8%) and sexual abuse (2.8%) were less common. Living in a nuclear family (AOR: 2.74, 95% CI: 1.67-4.51) and lower socio-economic status (AOR: 5.42, 95% CI: 2.28-12.92) were significantly associated with increase risk of elder abuse. Qualitative findings revealed mistreatment, vulnerability, negligence, economic factors, family dynamics, loneliness, financial exploitation, food withholding, physical abuse, and emotional attachment as key aspects of elder abuse. This study highlights neglect and psychological abuse were the most common forms of elder abuse. These findings emphasize the urgency of implementing programs at the municipal level such as financial support system for elderly individuals from lower socioeconomic backgrounds and education programs for both elderly individuals and their families and caregivers. These initiatives aim to control and reduce the incidence of elder abuse and ensure comprehensive well-being of elderly population.

Supporting older people experiencing homelessness and memory problems in hostels: Learning from an ethnographic study.

Older people with memory problems living in temporary hostel accommodation have longer stays and higher care needs than those without memory problems. In this ethnographic study, we aimed to elucidate how staff currently support older hostel residents with memory problems, what contextual factors determine support given and, what facilitates positive and meaningful outcomes for staff and residents. We conducted interviews and participant observations with older people (≥50 years) experiencing memory problems and homelessness (interviews n=17, observations n=13), hostel staff and managers (interviews n=15, observations n=20) from seven residential facilities (six hostels and one care home), and health and social care practitioners (interviews n=17, observations n=7), from September 2021-December 2022 in London, England. We analyzed thematically from a critical realist position. We identified four overarching themes: (1) Compensatory strategies and routines, (2) hostels are not homes, (3) meeting challenging interactions with compassion, and (4) facilitating opportunities for meaningful interactions. Social interactions for people with memory problems were restricted and, although sheltered by living in hostels, this did not equate to safety or provide opportunities for positive interactions. Staff worked hard to connect with older residents with memory problems, in resource and time-poor contexts, often left to provide care beyond their roles in contexts of unmet need. Our ethnographic account has informed co-design of a support intervention for hostel staff working with older people with memory problems, alongside recommendations for policy and practice.

Validity and Reliability Study of the Turkish Form of the Family Support Scale for the Older People.

The Family Support Scale is a used scale to assess family support in older people. The purpose of this study was to test the Family Support Scale for older people in Turkish and to examine its validity and reliability. This was a methodological study. This study sample enrolled 250 older individuals. The study was conducted between July-December 2022. In data collection, sociodemographic information form and The Family Support scale were used. The inclusion criteria for this study selected participants who were 65 years or older, literate, open to communication, living with at least one family member, and who volunteered to participate in the research. In the study, who developed the original scale, was contacted via e-mail and the necessary permission was obtained for the Turkish validity and reliability of the scale. Language equivalence, content validity, exploratory factor analysis, and confirmatory factor analysis of the scale were performed. Internal consistency and total item score correlation were calculated to ensure validity and reliability. The scale is compatible in terms of language and content suitability, CVI (Language)= 0.87; CVI (Content)=0.099. In the validity analyzes of the scale; the factor loadings values of the scale were found to be between 0.36 and 0.83, and the explained variance (54.78%) was at a sufficient level according to the EFA results. It was determined that factor loading values for all items were varied between 0.58 and 0.97 and factor load values were statistically significant in CFA (p<.05). It was determined that the fit indices were RMSEA=0.064, GFI=0.99, CFI=0.99, NFI=0.99, x2/df=2.03 at the desired level. In the reliability analysis, it was found that the internal consistency coefficient (α: 0.94) was quite reliable, and the total correlation values of the scale ranged between 0.48 and 0.83. The cross-cultural adaptation of this scale has been realized successfully in Turkish. Health care providers may utilize this tool to evaluate family support for older people.

Supporting older people in residential and nursing care homes and the older visitor during the winter

Adrian Ashurst discusses the important role that care homes can play in supporting older people during the colder months, both those visiting and those living in residential and nursing care homes.

Supporting older people during summer in nursing and residential care settings

Adrian Ashurst explains how to safely support older people when it is warm during the summer months.

Family Caregivers' Perceptions and Experiences of Supporting Older People to Cope With Loneliness: A Qualitative Interview Study.

Loneliness has become a significant public health issue among community-dwelling older adults particularly those with multimorbidity. Family caregivers are crucial care resources for dependent older adults living in the community before transitioning to institutional services. However, understanding of their perceptions in supporting older adults with multimorbidity to cope with loneliness is limited. This qualitative study aimed to elucidate on the experiences of caring and explore the experiences and perceptions of family caregivers in supporting older community-dwelling adults with multimorbidity to cope with loneliness. Eleven family caregivers, aged 51-93 years old, with at least 2 years of caregiving experience were purposively recruited and interviewed individually. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was utilised to report the study. Three key themes were generated from the inductive analysis: (1) recognising older adults' loneliness through the expression of unusual emotions, behaviour/s, social network alteration and speech; (2) variations in perceptions and responses to loneliness among different family caregiving relationships; and (3) challenges in addressing loneliness. Positive feedback from cared-for older adults was appreciated by their family caregivers which in turn motivated further actions to alleviate loneliness. The findings emphasised the importance of developing specific patients and family caregivers centred interventions, such as communication skills training to enhance effective communications. Cultural values and norms of individuals should be respected in those interventions, ensuring that emotional expression is facilitated in a comfortable way for both older patients and family caregivers.

Using critical reflection to enhance the care of older people: a practice example.

Reflection is an essential aspect of nursing practice that facilitates continuing professional development and practice improvement. Critical reflection is a more in-depth form of reflection and can be described as a creative, dynamic and transformative learning process that enhances practice by promoting self-awareness and critical thinking. Older adults often present with complex and multiple healthcare needs. Engaging in critical reflection can assist nurses to provide the high-quality, person-centred care required to meet those needs, support older people to retain their independence and enhance their well-being. This article discusses critical reflection within the context of nursing older people and describes various models that can be used to support the reflective process. The authors use a practice example to illustrate how using critical reflection in practice can enable nurses to develop a deeper understanding of themselves and use what they have learned to enhance their delivery of person-centred care.

The impact of residential environment on older people's capabilities to live independently: a survey in Beijing.

Studies have shown how environmental factors influence older people's health and functional limitations, which are crucial for achieving healthy aging. However, such a healthy aging model has been criticized for defining health as an absence of disease, because chronic conditions cannot be reversed through medical treatments. In response to such critiques, this study refers to Huber's positive health definition, arguing that health should not be defined as the absence of disease but as the ability to adapt and self-manage in the face of social, physical, and emotional challenges. There is a need to develop a community-based approach to healthy aging that considers how the residential environment enables older people to adapt and self-manage. Drawing on Sen's capability approach, this study proposes that such a community-based approach should provide a supportive environment to enable older people's capabilities to live independently. Using hierarchical multiple regression analysis of data from 650 older people (60years and older) surveyed in Beijing, we unravel which features of the residential environment support older people' s capabilities to live independently and how these impacts differ depending on older people's frailty levels. The results show that four environmental factors, namely perceived accessibility (B = 0.238, p < 0.001 for physical capability, B = 0.126, p < 0.001 for social capability, B = 0.195, p < 0.001 for psychological capability), pleasant surroundings (B = 0.079, p < 0.05 for physical capability, B = 0.065, p < 0.05 for social capability), meeting opportunities (B = 0.256, p < 0.001 for social capability, B = 0.188, p < 0,001 for psychological capability, and life convenience B = 0.089, p < 0.05 for physical capability, B = 0.153, p < 0.001 for psychological capability) positively affect older people's capabilities to live independently. These four environmental factors cause differences in older people's capabilities between different neighborhood types. Moderation analysis shows that meeting opportunities are more relevant for frail older people (B = 0.090, p < 0.001 for social capability, B = 0.086, p < 0.01 for psychological capability). This study contributes to the literature by emphasizing the role of supportive residential environments in enabling older people to live independently. Furthermore, we identify four environmental factors that support older people's capabilities. Results can be used to develop effective community-based environmental support to enable older people to live independently.

중국 노인 레저스포츠 안전의식과 안전조치에 대한 현황조사연구

The purpose of this study is to explore the sports safety awareness, insecurity, implementation of safety protection measures and related influencing factors to improve the safety of sports leisure activities in the elderly.This paper adopts the questionnaire survey method and selects 400 elderly residents in Xinxiang city, aged over 60 years old, as the survey objects. Through the investigation and analysis, we find that elderly people have a certain awareness of sports safety, but there are differences between different education levels and age groups. The main reasons for sports injury in the process of exercise are lack of scientific fitness knowledge, lack of understanding of body physiology and muscle degradation, lack of professional fitness guidance, physical exhaustion/poor physical condition, excessive amount of exercise, equipment of origin will not be used or damaged, organization and management is not standardized/imperfect, poor awareness of self-protection and other factors. The factors that affect the implementation of sports safety protection mainly include education level, economic status, professional guidance and safety facilities of sports venues. This study emphasizes the safety of leisure sports activities for the elderly, and puts forward suggestions to improve the safety of leisure sports activities for the elderly, including providing more professional guidance, improving sports facilities, encouraging moderate exercise, and establishing a sports monitoring system for the elderly. The government should strengthen the sports infrastructure, especially the supporting safety facilities, add obvious signs of safety facilities, and establish a response plan for sports injury accidents, which will help the elderly better enjoy the benefits of leisure sports activities and improve their quality of life. The findings can be used to guide policy development and health promotion activities to help support older people to have a more active lifestyle in the process of healthy aging in order to improve the quality of life of older people.

Effects of Anxiety, Stress and Perceived Social Support on Depression and Loneliness Among Older People During the COVID-19 Pandemic: A Cross-Sectional Path Analysis.

During the COVID-19 pandemic, older people were exposed to high levels of anxiety and stress leading to loneliness and depressive disorders. The purpose of the present study was to investigate the effects of anxiety, positive coping, perceived social support, and perceived stress on depression and loneliness among older people during the COVID-19 pandemic. This was a cross-sectional online/telephone survey. A non-probability convenience sampling method was used. Participants were 112 people aged 60 years and above, without cognitive impairment, who experienced confinement (from March 2020 onward) and had access to the internet or telephone. A path analysis model showed a direct significant effect of anxiety on both, depression (β = .68, P < .001) and perceived stress (β = .65, P < .001), as well as an indirect effect of anxiety on loneliness via perceived stress (β = .65) * (β = .40); and social support (β = -.21) * (β = -.20). The model showed adequate fit χ2(df = 4) =5.972, P = .201; RMSEA = 0.066 (0.000, 0.169), CFI = 0.992; TLI = 0.970. Anxiety had a significant effect on depressive symptoms as well as on loneliness via perceived social support and perceived stress. According to our findings, in order to reduce depressive symptoms and perceived loneliness, it is essential to develop timely interventions that decrease levels of anxiety and stress and increase levels of perceived social support in older people, particularly when there are any restrictions, physical or contextual, that prevent face-to-face contact. This can be achieved by implementing preventive community-based programs, enhancing accessibility to mental health services, and collaborating with local support groups, among others.

ElliQ, an AI-Driven Social Robot to Alleviate Loneliness: Progress and Lessons Learned.

Loneliness is a significant issue in older adults and can increase the risk of morbidity and mortality. To present the development of ElliQ, a proactive, AI-driven social robot with multiple social and health coaching functions specifically designed to address loneliness and support older people. ElliQ, a consumer robot with a friendly appearance, uses voice, sounds, light, and buttons through a touch screen to facilitate conversation, music, video calls, well-being assessments, stress reduction, cognitive games, and health reminders. The robot was deployed by 15 government agencies in the USA. Initial experience suggests it is not only highly engaging for older people but may be able to improve their quality of life and reduce loneliness. In addition, the development of a weekly report that patients can share with their clinicians to allow better integration into routine care is described. This paper describes the development and real-world implementation of this product innovation and discusses challenges encountered and future directions.

Social participation in older people with hearing impairment in Chinese community: A latent profile analysis

ObjectivesHearing impairment may lead to increased communication difficulties for older people, making their social participation less optimistic. However, there is little research on the social participation of older people with hearing impairment, especially based on the characteristics of their social participation. This study aimed to identify different social participation profiles in older people with hearing impairment and to explore sociodemographic characteristics, disease-related characteristics and psychosocial factors with different social participation profiles. MethodsA cross-sectional study of 300 older people with hearing impairment using the sociodemographic questionnaire, the Impact on Participation and Autonomy Questionnaire, the Lubben Social Network Scale-6, Medical Outcomes Study Social Support Survey and Geriatric Depression Scale-15 from May to August 2023 in a community of Beijing, China. Latent profile analysis was used to analyse the latent profiles of social participation in elderly with hearing impairment. Multiple logistic regression was used to explore the predictors of different profiles. ResultsThe social participation of older people with hearing impairment in the community can be classified into three potential profiles: Profile 1 - high social participation group (76.05 %), Profile 2 - moderate social participation group (17.34 %), Profile 3 - low social participation group (6.61 %). Age, types of chronic diseases, self-reported health, severity of hearing impairment, social network, social support and depression were predictors of different profiles. ConclusionsNurses should pay attention to the characteristics, depression, social network and support of older people with different hearing impairment to improve social participation in different profiles. Implications and recommendationsThis was the first study exploring latent profiles of social participation in older people with hearing impairment. Insights from this study are useful for gerontological nursing to distinguish different profiles and further identify the characteristics of different profiles in older people with hearing impairment by characterizing the level of social participation in the community and better implement interventions according to profiles.

The effects of a mindfulness-based programme on quality of life and social support in older people

Abstract The importance of mindfulness in promoting mental health and well-being has been increasingly recognised in recent years. As a result, mindfulness-based interventions have been introduced to improve various aspects of life, including quality of life and social support. The aim of this study was to examine the effectiveness of a seven-week mindfulness-based workshop programme in improving quality of life and social support among participants in the intervention compared to a control group. A total of 257 participants (65+) were recruited and assigned to either the intervention group, which participated in the seven-week mindfulness-based workshop programme, or the control group, which received no intervention. The workshop programme combined two evidence-based programmes: The Chronic Disease Self-Management Programme (CDSMP) and the Mindfulness-based Living Programme. Participants completed two questionnaires (EQ-5D-5L and OSSS-3) to assess quality of life and social support before and after the intervention. Data were analysed using appropriate statistical tests to compare pre- and post-intervention outcomes between groups. The intervention group showed significant improvement in quality of life (p&amp;lt;.001) and social support scores (p = 0.002) after the seven-week mindfulness-based workshop programme. The control group, on the other hand, showed no significant changes in these measures. The significant improvement indicates the effectiveness of the mindfulness-based workshop programme. The results of this study show the positive effects of a seven-week mindfulness-based workshop programme on the quality of life and social support of older people. The results suggest that mindfulness-based interventions can be an effective tool for improving mental health and well-being by promoting quality of life and strengthening social support networks. Key messages • The seven-week mindfulness-based workshop programme improves the quality of life and social support of older people, which can have an impact on overall mental health and well-being in general. • The results of this study can ensure a sustainable impact on achieving better health outcomes and saving resources in the health care system through reduced and more effective use of services.

Assessing Feasibility of Cognitive Impairment Testing Using Social Robotic Technology Augmented with Affective Computing and Emotional State Detection Systems.

Social robots represent a valid opportunity to manage the diagnosis, treatment, care, and support of older people with dementia. The aim of this study is to validate the Mini-Mental State Examination (MMSE) test administered by the Pepper robot equipped with systems to detect psychophysical and emotional states in older patients. Our main result is that the Pepper robot is capable of administering the MMSE and that cognitive status is not a determinant in the effective use of a social robot. People with mild cognitive impairment appreciate the robot, as it interacts with them. Acceptability does not relate strictly to the user experience, but the willingness to interact with the robot is an important variable for engagement. We demonstrate the feasibility of a novel approach that, in the future, could lead to more natural human-machine interaction when delivering cognitive tests with the aid of a social robot and a Computational Psychophysiology Module (CPM).

Care and support for older people with intellectual disabilities beyond the pursuit of ageing ‘in place’: towards constructing a space to be(long)

ABSTRACT Whereas population ageing has been a much debated issue over the last decades, the political and scientific awareness of the longevity of adults with intellectual disabilities is considered relatively new. When the situations of older people with intellectual disabilities are coming into focus, attention has especially been drawn to medical aspects or to expected challenges of their ageing for health and social service providers. In that vein, a prominent yet rather wicked issue has been the question whether either disability care or elderly care services are the right place to meet their needs. This article discusses findings of a qualitative research study that aimed to reconstruct and investigate 10 care trajectories of ageing people with intellectual disabilities. Based on open interviews with the individuals themselves and with significant others from their formal and informal networks, we identified mechanisms in society that allow or deny older people with intellectual disabilities access to certain care settings or welfare provision. Moreover, we discovered concerns, interests and aspirations that are often left unseen. This shows the necessity to go beyond the debate of ‘ageing in (or out of) place’, and challenges us to create opportunities and strategies to create ‘a space to be(long)’.

Results of the Italian RESILIEN-T Pilot Study: A Mobile Health Tool to Support Older People with Mild Cognitive Impairment.

(1) Background: The RESILIEN-T system addresses the need for innovative solutions to support self-management in older people with Mild Cognitive Impairment (MCI). Despite the increasing prevalence of dementia and MCI, there is a lack of tailored solutions for these individuals. The RESILIEN-T system aims to empower and engage people with cognitive decline by providing a modular platform for self-management and coaching services. (2) Methods: Italian data collected for the RESILIEN-T project involved 62 older participants randomly assigned to the intervention or control group. Data were collected through questionnaires and user interactions with the system over a three-month period. (3) Results: Quantitative outcomes showed no significant differences between the intervention and control groups, except for an improvement in perceived memory capability in the intervention group. The usability assessment indicated a high level of acceptance of the RESILIEN-T system. (4) Discussions: Although no significant improvements were observed in most quantitative measures, the high user engagement and acceptance suggest the potential effectiveness of the RESILIEN-T system. Future improvements could involve integrating smart objects and interactive virtual agents. Overall, RESILIEN-T represents a promising step toward empowering individuals with cognitive impairment in their self-management and decision-making processes.

Nighttime Home Care in Sweden: “A Constant Struggle to Manage Unforeseen Events”—Operations Managers’ Perceptions of Organization and Provision of Care for Older People

This article aims at exploring how community home care of older people is provided and organized at night. In times of welfare decline, organizational changes, and an increasing aged population, questions arise about home care and support for older people. In Sweden, as in many other Western countries, “ageing in place” is a guiding principle in care provision for older people, which put increasing pressure on home care services. Still, nighttime care represents a research gap within health and social care research, nationally and internationally. This telephone interview survey examines 41 operations managers’ perceptions of organization and care provision and how they account for the goals and work of home care at nighttime in a selection of 37 Swedish municipalities. The analysis was inspired by thematic content analysis where three central themes were categorized: organizational context of nighttime care, working conditions, and challenges of nighttime care. Our results reveal that organizational context varied depending on the demography and size of the municipality. The work situation was characterized by constantly unforeseen events to manage. Multiple challenges were identified on societal and political levels, as were limited resources and recruitment problems. In conclusion, our analysis has identified unpredictability as a core feature of nighttime care work. The complexity of the provision of nighttime care was not recognized as important for the municipal organization. To provide high-quality care at night in ordinary housing, there is a need both to focus on organizational aspects and to have sufficient resources and time.