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Norway is often referred to as ‘the best place to grow old’. We interview Professor Terje P. Hagen from the Department of Health Management and Health Economics at the University of Oslo, to find out why.

Over the past two decades, Norway has redefined the way it cares for its ageing population. Long recognised as a “good place to grow old” - with HelpAge International research showing it has the highest global level of well-being for over-60s - it was a nation that in the past tended to place relatively high numbers into residential and nursing homes. That emphasis, however, has now shifted towards keeping older people in their own homes for longer and delivering care in the home.

Responsive to social care needs 

The Government Pension Fund Global, funded from the country’s oil wealth, helps finance the demands of an ageing population, but that cash cushion is now coupled with a culture change backed up by various legislation.

As one of Norway’s leading authorities on this, Professor Terje P. Hagen at the University of Oslo, explains: “To an increasing degree, older people with care needs are supported at home, either in their original home or in sheltered housing, which in Norway is also legally defined as a personal home. People are to a lesser degree taken care of in nursing homes or other institutions, although this is still an alternative in terminal stages.”

Everyday Rehabilitation at Home 

Support at home is given as nursing and practical assistance, with physiotherapy and other care. A new model called Everyday Rehabilitation at Home has been implemented in several communities to encourage the those in need of support to manage their own health and remain independent.

The approach is multi-disciplinary with social workers and care professionals delivering comprehensive services at a local level for all citizens irrespective of age, diagnosis, economic situation, social status, or other factors.

Norwegian municipalities are responsible for taking care of older people, which also makes it possible to integrate that with care for other user groups, says Professor Hagen. The process began in the 1970s when legislation was introduced to start the process of transferring roles and responsibilities from the state to local government.

Milestones include the Municipal Health Services Act (1983), which made municipalities responsible for primary health services; the nursing home reform (1989); reform for people with intellectual disabilities (1991); and reforms within psychiatry (1997).

Professor Hagen explains: “Segregated special care and institutional care have been dismantled in favour of enhanced integrated home care services and new living arrangements in communities. Thus, the focus has shifted from special care to common solutions that are adaptable to nearly all service recipients.” 

Reforming care 

Another key stage in re-inventing health and social care in Norway was the Coordination Reform in 2012. It aimed to make municipalities more capable of addressing health issues through early intervention and halting the development of disease by educating those at risk of developing serious illnesses.

However, he added: “These changes require new approaches to care work and the development of services to perform these tasks. An example of the new initiatives is the Healthy Life Centres, which actively target specific groups such as smokers and people with obesity.”

The Reform resulted in municipal co-financing of patients treated in the state-owned specialist health care services, and made municipalities financially responsibility for patients ready for discharge.

This was enforced with the introduction of a daily fee - 4000NK/390 euro/£350 - to reduce bed-blocking and to be paid by the municipality to hospitals for patients declared ready for discharge but unable to leave the ward because municipal services were unavailable.

Initial research indicated that the fee reduced the length of stay in hospitals for patients, with no change in mortality and readmission rates, he said. The reform package also encouraged local authorities to build up services to tackle the increased care burden. 

Centres for care research 

Norway has a number of research facilities analysing caring for an ageing population, including the Centre for Care Research West Norway, a cross-disciplinary research centre hosted by Bergen University College; one of five regional centres for care research. Professor Hagen’s centre, part of the Faculty of Medicine at the University of Oslo, conducts research and teaching in the fields of health economics, policy, management and systems of care, and quality of care.

He acknowledges the success of the Coordination Reform remains disputed among experts, but says there has been many benefits, as the global over-60 population heads towards two billion - a fifth of the world’s population - by 2050.

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