Continuity and change in Norwegian Nursing homes: an example from a long-term study in an urban home.

This paper discusses to what extent continuity or change characterizes recent development of Norwegian nursing homes, focusing on organizational and architectural development of these institutions. While home-based care is increasingly developed in the municipalities, nursing homes play a more significant role in the care for the elderly sick in Norway than in most other European countries (Statistics Norway 2007). Care for elderly sick in medically specialized hospital settings, though, is less pronounced in Norway than in the rest of Europe. Hence the care for elderly sick may be said to be less a part of high-tech medical surroundings and more decentralized in Norway than in the bulk of European countries, with most nursing homes close to the home communities of the patients. This is a challenge both economically and in terms of infrastructure with regard to the sparse and dispersed population of Norway. How this challenge is met, has been changing during the latest two decades. To some extent, governmental responses at state and municipal level seem to be affiliated with trends linked to New public management (NPM) (Christensen & Syltevik 1999), aimed at making the long-term residential care more cost efficient. Other changes, like changes in the architecture and physical outline in the facilities, are rather costly and may be driven by other forces (Jacobsen & Mekki 2011).Care in nursing homes takes place within the frames of architectural and physical surroundings where these surrounding constitute an important dimension in how care is realized and practiced each and every day. Even though the internal and external physical surroundings, routines linked to place and physical space and staff culture varies somewhat between individual nursing homes in Norway, there also exist marked similarities between the nursing homes. Moreover, although some important changes have taken place with regard to architectural outline and financial and organizational models in the latter decades in Norway, still pronounced continuities exist. Based on ethnographic fieldwork, this presentation in particular focuses on continuity and changes in one urban nursing home throughout more than 20 years since 1988, a time span which includes a rebuilding of the institution in 2003.