Preventive and health-promoting home visits to the elderly

Increasing occurrence, but not compulsory for the municipalities

The Initiative of preventive home visits to older people has increased over the last decade in Norway. In 2016, the government published a circular and in 2017 guidelines to encourage the municipalities to establish this service. Unlike in Denmark, preventive home visits are not compulsory for Norwegian municipalities.

The effect of the visits is unclear, but feedback from the users and the municipalities is positive

Research from countries with similar services shows that the visits have varied effects when it comes to measurable aspects of the receivers’ daily and physical function, health condition, self-defined quality of life, tendency to fall, hospitalisations, need of nursing homes, time of death and public expenses. Methodological differences, differences in the content of the visits and differences in healthcare systems make it difficult to be unambiguously when it comes to such effects. Qualitative research from the Nordic countries shows that the receivers had vague expectations before the visits. Afterwards, however, they stated that the information they received was useful in terms of how to maintain good health and how to manage daily life in old age. In addition, the visit gave them an increased sense of security because they now had a person in the municipality, which they could contact when needed in the future. The majority of municipalities providing the service express that they see positive benefits from the service.

Key points in order to succeed

Since 2012, in Norway, several evaluation and R&D reports about the content and methods for the visits have been published. They state that in order to succeed the municipalities should: 

• Make sure the service has support both at the political and professional leadership.
• Organise the service close to pre-existing preventive and homebased services, and in cooperation with the GPs.
• Be conscious about the purpose, content and target groups for the visits.
• Recruit employees with relevant competence and personal skills.
• Create realistic expectations among the elderly by providing information about the service prior to the visits.
• Mail out letters with information, including a scheduled point of time for the visit, so that the older adult actively has to cancel if he or she does not want the visit. Build a safe and trusting atmosphere during the visit and makes sure that note-taking (registration) does not disturb the conversation. The written guide to conversation should be “second nature” to the employee and adjusted according to the individual need of the older adult.
• Conclude the visit by summarizing the points discussed and determine whether or not a follow-up or a referral to others is necessary. Provide the contact information of the visitor and the municipality so that the older adult is able to contact if needed.
• Evaluate the service and use statistics from the visits in the plan processes within the municipality. 

We need more knowledge concerning:

• The health effects of the visits and the effect on the public finances in Norway.
• What elements of the home visits are particularly effective.
• How the service can be further developed, also through cooperation and division of labour with the volunteer sector, the GPs and municipal initiatives in public health, tele care, dementia care and reablement.
• Alternative preventive and health promoting services for older people, for instance group meetings.