Over the past few years, Norway has signaled that it wants communities to take a larger role in caring for its elderly citizens. Politicians and healthcare regulators argue that the budget and personnel simply cannot keep up. To avoid reducing services, they are asking older people to take greater responsibility for their housing, health, and social support network.
Will this plan work?
“That’s what we are going to find out” says Professor Hilde Hatleskog Zeiner. She is running a five-year study to understand how municipalities build care capacity and how the population responds to this shift in responsibility.
“Everyone agrees we can’t continue as today, but it’s not clear if people are going to change.”
Growing elderly care needs
Zeiner has worked in the Ministry of Health and now conducts research on sustainable development in Norway’s municipalities.
According to her, the municipalities are leading this change.
“The municipalities are signaling that they can't afford to provide the services the state requires them to provide. They need help from National Health authorities to shift some responsibility from public services to individuals and the elderly themselves.”
The pressure results from national requirements to deliver extensive services with limited budgets and healthcare providers.
Public authorities maintain that the issue is training more caregivers to support these services. The state has a responsibility to ensure that elderly people can continue to live a full life.
This includes housing and healthcare and also housekeeping, meal preparation, and other services that are essential for personal hygiene, mobility, and overall well-being.
Over the past 10 years, Zeiner says municipalities have struggled to meet these demands. A third of municipal budgets go to healthcare and costs have increased dramatically since Covid.
Local authorities say that the block grants from the state are not sufficient. Older people are getting their healthcare needs met, but receive fewer social services.
Building community support
Whether the root problem is money, personnel, or both, public authorities are trying to solve it by reducing demand.
“There is a marked shift in the way that public authorities think about these services from building capacity to finding solutions by cooperating more closely with other sectors of society.”
This means relying on families and industry to ensure that people can live safely at home.
Zeiner says municipalities hope they can rely on citizens, local communities, and users to reduce demand for services. Otherwise, the system may grow out of control.
The response seems to be ‘we are expected to work full time and care for our children, and now you need us to care for our parents too?'– Hilde Hatleskog Zeiner
The plan to shift responsibility
Enacting this shift in elderly care depends on state regulations, state funding, and many different programs.
Zeiner’s research focuses on evaluating four aspects of this plan: housing, age-friendly communities, the people involved in the services, and the services themselves.
Housing is a critical part of the equation.
There are many regional variations and therefore different challenges to address. For example, housing prices in Oslo exclude nearly all single-earner families, while builders in rural areas have no financial incentive to build new houses and few people want to buy existing ones. On top of these issues, Norway has limited social housing.
This often leaves municipalities with needing to provide community housing or leaving people living in houses that don’t meet their needs.
Zeiner is also concerned about whether national and local authorities will be able to cooperate across sectors.
“Will the transport or mobility sectors be compatible with the aims of the healthcare sector?”
People react to the plan
There is also the question of whether individuals will accept the additional responsibility for themselves and their families.
“Older people have understood the message,” Zeiner says. Surveys indicate that they are ready to take greater responsibility for their own health and care. Many consider taking steps like changing lifestyle and going to the gym to be just like saving for a pension.
On the other hand, adult children seem to be wary of the changes. “The response seems to be ‘we are expected to work full time and care for our children, and now you need us to care for our parents too?’” says Zeiner.
She stresses that adults are already asked to take much more responsibility than we realize. This is true even if we believe the state will take care of everything.
The message is key
“My hunch is that it would be better if the authorities were more open about the actual challenges and what the plan will look like” says Zeiner. She feels that authorities have not properly explained what this shift will mean. People need clear information about what they will need to do and how it will affect their services. They also need to understand that the ultimate goal is to save these services without increasing the costs.
She sees two possible scenarios.
If authorities can convince people to take more responsibility for themselves and their communities, services can remain the same as today. People will be able to live individually at home, even with disability. This should mean better health outcomes and fuller lives.
On the other hand, poor messaging, insufficient planning, and what Zeiner calls “too much hope” will make people not support the program. In that case, she fears that healthy and wealthy citizens will buy services privately and be able to stay in their homes while the rest of the system breaks under the extra load. It’s not clear what this would look like.
Watching what happens
Both the shift in elderly care and Zeiner’s research are just getting started. Over the next five years, she will be following the changes closely. She doesn’t know yet which scenario will come to pass.
“It will be really interesting to see if we actually succeed in providing more in the mobility sector, housing sectors, and municipal planning and find out whether that actually has an effect on the demand for services in the health and care sector.”
