Elderly Care in Transition - the Older Persons' and the Staff's Perspective

Elderly care has and is facing several challenges with an increasing number of older people and fewer of working age. Strengthening the positive aspects will be central and creating good conditions for older people and staff for high quality care. Elderly care where both staff and the older people enjoy a health-promoting, preventive and person-centered approach and with good accessibility to services that facilitate faster transitions.

In one of the municipalities in this research project, they will introduce measures without individual needs assessment by an social welfare officer and they will carry out a training program for staff. The training will focus on changes in legislation (SoL 2025:400), changed working methods with a focus on the person and their needs (person-centered approach, participation, accessibility, health promotion and prevention) and motivational interviews. Every person with elderly care will have a permanent care contact who has undergone the training. A new preventive unit will be formed. The project is part of a larger program at the University of Gävle where the focus is on person-centered care for older people.

In the other municipality (comparison) certain changes are also taking place but to a lesser extent, interventions without individual needs assessment are not planned within the next year on any large scale. On the other hand, preventive and health-promoting activities are being expanded, but on a smaller scale.

The changes are the responsibility of the municipalities and the researchers intend to follow the changes that are taking place and has nothing to do with the changes themselves. Questionnaires will be given to older people covered by home care in two municipalities (one where the changes are taking place and a comparison municipality) and to the staff working in home care before and after the changes have taken place.

The overall aim of the study is to investigate 1) the experience of older people and 2) staff of a changed way of working in home care in one of the municipalities and compare it with a municipality where smaller changes are taking place. In addition, to study the relationship between estimates of person-centered care/service, quality of care, health and well-being in elderly care for the older people and the relationship between estimates of person-centered care/service, quality of care and quality of working life for the staff.

• What changes occur over time

1. in older peoples' rating of person-centered care/service, quality of care/service, health and well-being before and after the introduction of the new working method in one of the municipalities and are there any differences in these variables over time compared to another municipality where minor changes are implemented?
2. in staff-rated person-centered care/service, quality of care/service, and quality of working life, and are there any differences compared to a comparison municipality?

The main question that the study aims to answer is: are there any changes in person-centered care, as rated by older people and staff, over time in the municipality with changed working methods within home care and compared to a comparison group/municipality?

Study Overview

• Status: Not yet recruiting
• Conditions: Older People With Home Care; Staff Working With Older People in Home Care

Detailed Description

Power is calculated based on a small (0.20) to medium (0.50) effect size (Cohen's d), which is common in nursing. On average, in nursing, an effect size of 0.35 has emerged, corresponding to a need for 129 participants in each group with a power of 0.80 (Polit and Beck 2025) (394 small effect and 64 medium).

Older people: We survey everyone with home care in both municipalities. The approximate number of people with home care in January/February 2026 in the intervention municipality was approximately 700, and the comparison municipality 700, which may of course change. Measurements will be taken before the change and after (12 and 24 months after the first measurement). Estimated response rate 50% and additional dropouts are included in measurements over time. In summary, our estimate is approximately 300-400 participants over time per municipality, which gives us sufficient basis for the average effect size that has been measured in nursing.

Staff : All staff in the municipality where the intervention is implemented who work with care/service for the elderly in their own homes (approximately 150 assistant nurses, 50 care assistants) will be asked about participation, as well as all staff - equivalent - in a comparison municipality (approximately 380). For power in this study, the same calculation is used as for the elderly, which means that we need approximately 129 participants in each group.

Data will be analyzed using analytical statistics, e.g., ANOVA, ANCOVA or GEE (Fitzmaurice et al., 2011) (to account for clustering) to study the intervention/change in behavior over time or non-parametric tests depending on whether the data is normally distributed or not. For analyses of relationships, bivariate correlation analyses and multiple regression analyses.

• Study Type: Observational
• Enrollment (Estimated): 1980

Contacts and Locations

• Study Contact: Name: Maria Engström Professor, PhD; Phone Number: +4626648215; Email: maria.engstrom@hig.se
• Study Contact Backup: Name: Annika Nilsson Professor, PhD; Phone Number: +4626648282; Email: Annika.Nilsson@hig.se

Study Locations

• Sweden
  • Gävle, Sweden, 80176
    • University of Gävle
    • Contact: Annika Nilsson Professor, PhD; Phone Number: +4626648282; Email: Annika.Nilsson@hig.se
    • Contact: Maria Engström Professor, Professor; Phone Number: +4626648215; Email: maria.engstrom@hig.se

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

1. Older people 70 years or more in two municipalities who have home care/service.
2. staff working in home care/service in these two municipalities

Description

Inclusion Criteria - older people:

• age 70+
• having home care and
• able to respond to a survey.

Exclusion Criteria - older people:

• those with only food distribution and/or
• those with only alarms.

Inclusion Criteria - staff:

- home care staff in the two municipalities, no age limits for the staff.

Exclusion Criteria - staff:

• those on leave and
• those on short-term/hourly employees.

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort
Older people intervention group; The intervention/changed working method consists of a transition to measures without individual needs assessment by a social welfare officer, and staff training. Training: changes in legislation (Social Services Act 2025:400), changed working method focusing person-centered care, participation, accessibility, health promotion and prevention, and motivational interviews. Every person with home care will have a permanent care contact who has undergone training. A new preventive unit will be formed with the mission to guide citizens to the right type of measures or other forms of support and to ensure that the interventions are designed based on the individual's needs and resources in an initial stage. The unit will work in an outreach and preventive manner. The municipality is responsible for the intervention, which is implemented regardless of the researchers' participation or not and the researchers follow the project with survey data and interviews.
Older people comparison group; In the comparison municipality, certain changes are also taking place, but to a lesser extent. Measures without individual needs assessment by a social welfare officer are not planned on any large scale within the next year. However, preventive and health-promoting activities are being expanded, but on a smaller scale.
Staff intervention group; The intervention/changed working method consists of a transition to measures without individual needs assessment by a social welfare officer, and staff training. Training: changes in legislation (Social Services Act 2025:400), changed working method focusing person-centered care, participation, accessibility, health promotion and prevention, and motivational interviews. Every person with home care will have a permanent care contact who has undergone training. A new preventive unit will be formed with the mission to guide citizens to the right type of measures or other forms of support and to ensure that the interventions are designed based on the individual's needs and resources in an initial stage. The unit will work in an outreach and preventive manner. The municipality is responsible for the intervention, which is implemented regardless of the researchers' participation or not and the researchers follow the project with survey data and interviews.
Staff comparison group; In the comparison municipality, certain changes are also taking place, but to a lesser extent. Measures without individual needs assessment by a social welfare officer are not planned on any large scale within the next year. However, preventive and health-promoting activities are being expanded, but on a smaller scale.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Older peoples' rating of Person-centered care	The scale Person-Centred Practice Inventory - Care [PCPI-C] will be used to measure older peoples' ratings of person-centered care,18 items, each rated on a 5- point Likert scale from strongly disagree (1) to strongly agree (5), mean score is calculated and a higher score means more person-centred care.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated person-centered care	The Person-Centred Practice Inventory - Staff (PCPI-S) will be used to measure staff-rated person-centred care, 59 items, 5-point response alternatives, mean score is calculated and a higher score represents a more person-centred care.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Older peoples' rating of their health/wellbeing -EQ-VAS	Survey, scale for health EuroQol - (EQ)- VAS, scores 0-100, higher scores better health	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Older peoples' rating of their health/wellbeing - Life satisfaction	Survey, the Life Satisfaction Questionnaire with scores 0-100, higher scores a more desirable outcome for wellbeing	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Older peoples' rating of their health/wellbeing - Depression	Survey, the Patient Health Questionnaire PHQ-2 will be used that gives a score for depression 0-6, higher score more depressive symptoms, each item rated from 0 ( "not at all") to 3 ( "nearly every day"),	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Older peoples' rating of their health/wellbeing - Anxiety	Survey, the Generalized anxiety disorder scale GAD-2 will be used that gives a score for anxiety 0-6, higher score more anxiety symptoms, each item rated from 0 ( "not at all") to 3 ( "nearly every day").	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Older peoples' rating of their health/wellbeing - Loneliness	The UCLA 3-item loneliness scale will be used to measure loneliness. Higher scores indicating more loneliness. Each item rated on a 3-popint scale 1)hardly ever 2) some of the time, 3)often. Total score of the scale is the sum of the three items ( scale range 3-9).	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Structural conditions/empowerment	To measure structural conditions/empowerment the 19-item Condition of work effectiveness scale-II (CWEQ-II) will be used. The total score for the scale range from 6 to 30, higher scores representing better structural conditions. Response alternatives each item are 5-grade (1. None to 5. A lot).	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Thriving	The 10-item Thriving scale will be used to measure thriving, 5-point response alternatives. For total score the mean is calculated and a higher score means higher thriving.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Stress symptoms	Stress symptoms will be measured using the Psychosomatic Health Aspects Scale, one factor 10 items. Response alternatives are 5-grade [1) very often, 2) Quite often 3) Sometimes 4) Seldom 5) Never]. Scores from the ten items are averaged for factor score, and higher scores represent more stress symptoms.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Intention to leave	One question on intention to leave from the Satisfaction with work questionnaires, 'Have you recently seriously considered quitting your job on the unit because you don't enjoy it?', with response alternatives 1) No, 2) Yes, but I have not done anything and 3) Yes, and I have taken action	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Job satisfaction	The 4-item Brief Index of affective job satisfaction will be used. Items are averaged to get the total score and higher scores represent higher job satisfaction	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Psychological empowerment	Spreitzer's Psychological Empowerment scale will be used, 12 items that are averaged and higher scores representing higher psychological empowerment. 7-point response alternatives for each item.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Work-life conflict	The factor work-life conflict from the Copenhagen Psychosocial Questionnaire COPSOQ III will be used, three items that are averaged, response alternatives on a 5-point scale.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Quantitative demands	The factor quantitative demands from the Copenhagen Psychosocial Questionnaire COPSOQ III will be used, three items that are averaged, response alternatives on a 5-point scale.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Emotional demands	The factor emotional demands from the Copenhagen Psychosocial Questionnaire COPSOQ III will be used, two items that are averaged, response alternatives on a 5-point scale.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of working life - Burnout	The factor burnout from the Copenhagen Psychosocial Questionnaire COPSOQ III will be used, three items that are averaged, response alternatives on a 5-point scale.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Older peoples' rating on Quality of care	Study specific questions on how the older people rate the care they receive	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).
Staff-rated quality of care	Study-specific questions are used for self-efficacy, accessibility, preventive measures, health promotion, and satisfaction with care/service.	Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).

Collaborators and Investigators

• Sponsor: University of Gavle

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): October 31, 2028
• Study Completion (Estimated): October 31, 2028

Study Registration Dates

• First Submitted: March 18, 2026
• First Submitted That Met QC Criteria: March 25, 2026
• First Posted (Actual): March 31, 2026

Study Record Updates

• Last Update Posted (Actual): March 31, 2026
• Last Update Submitted That Met QC Criteria: March 25, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: person-centered care; Elderly care in transition
• Other Study ID Numbers: HIG-FORSK 2026/32

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The data set with individual data are not available to share due to general data protection regulations (GDPR), and in line with the ethics application.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No