Context: Spanish long-term care (LTC) is extensive, but is now striving to deinstitutionalize and provide care in the community. Covid seriously affected older Spaniards and many of them have housing problems and live alone. This has led to a growing interest in housing alternatives such as cohousing. Senior cohousing is expanding—a trend also seen internationally—but there is still little information about these alternatives. Objective: To describe the distribution and characteristics of senior and intergenerational cohousing initiatives in Spain and their relationship with national and regional deinstitutionalization and LTC policies, and to explore whether their municipal distribution co-occurs with selected area-level indicators of population ageing, income vulnerability, older-person household structure, housing context and regional LTC-system pressure. Methods: We conducted a multi-component descriptive study comprising a cross-sectional inventory of cohousing initiatives, by compiling information about Spanish senior and intergenerational cohousing initiatives from January 2025 to 31 March 2026 through specialist platforms, project websites, cooperative housing federation listings and by searching ‘cohousing y vivienda colaborativa’ in Google.es. Records were linked to official municipal statistics using National Statistics Institute (INE) municipality codes and other macroeconomic variables. We calculated counts, percentages and area-level descriptive summaries and produced maps in R version 4.5.1. We also conducted a document review of national and regional policy, and an exploratory ecological linkage between project municipalities and area-level indicators. Results: We identified 274 project records (114 senior-only, 41.6%; 160 intergenerational, 58.4%). Fifty-five records (20.1%) were operational initiatives; the remainder were planned or under construction. Of all records, 115 (42.0%) were in Cataluña. The spatial distribution did not consistently coincide with the highest values of the exploratory area-level need index. Limitations: There is no official register of cohousing projects in Spain. Implications: Spanish cohousing can be understood as a potential community-based response to territorially uneven needs. The combination of population ageing, income vulnerability, residential loneliness, housing shortage and regional LTC stress provides a stronger analytical basis for discussing the role of cohousing for deinstitutionalization policies.
Background: Demographic ageing and increased longevity are driving demand for social care. In the Netherlands, local councillors and policy advisors face complex decisions about how to allocate scarce social care resources. While local decision-makers have considerable discretion, they remain accountable to citizens. A recent study examined their views on what matters in allocating social care resources. However, little is known about citizens’ views, even though such insight is important for ensuring legitimate and responsive decision-making. Objective: To examine citizens’ views on what matters in the allocation of social care resources in the Netherlands. Methods: We conducted a Q-methodology study with 24 citizens. Participants ranked 39 statements reflecting considerations underlying decisions on the allocation of social care resources. We used factor analysis followed by varimax rotation to identify clusters in the rankings. We interpreted the clusters as viewpoints using the resulting factor arrays and qualitative data from post-ranking interviews. Results: We identified four distinct viewpoints, reflecting different value orientations: removing access barriers and autonomy; investing in social care; supporting income-based differentiation to ensure equal access; and balancing budget constraints with respect for autonomy. The viewpoints differed particularly regarding income-based differentiation, individual preferences and autonomy, and financial sustainability, while also showing agreement on several considerations. Conclusions: Citizens have different views on what matters in the allocation of social care resources, indicating that there is no single perspective to guide these decisions. At the same time, areas of agreement provide common ground that may support legitimate and responsive decision-making.
Context: Using communication tactics and reducing background noise are key staff behaviours to improve communication with long-term care residents, a population with high levels of hearing loss. Objectives: To identify barriers and enablers to these behaviours in long-term care settings. Methods: Semi-structured interviews were conducted with 23 staff who provide day-to-day care for residents in a long-term care home in Australia. Data were analysed using a hybrid approach, combining deductive thematic analysis based on the Capability, Opportunity, and Motivation model of Behaviour (COM-B), with inductive thematic analysis. Findings: Analysis identified multi-level barriers and enablers influencing aged care staff use of communication tactics and strategies to reduce background noise when interacting with residents. Key barriers included limited knowledge of residents’ communication needs and hearing status, variable awareness of the impact of background noise, difficulties adapting communication during busy periods, time and staffing constraints, unclear organisational protocols, environmental challenges, and communication difficulties associated with dementia and behavioural symptoms. Despite these challenges, staff were generally motivated to support effective communication and recognised its benefits for resident well-being, relationships, and care delivery. Important enablers included supportive managers and colleagues, staff experience and communication skills developed through practice, collaboration with families, access to communication-related information in care plans, visual prompts and cues, and positive beliefs about the benefits of communication strategies and noise reduction. Staff also reported that effective communication improved resident cooperation, reduced distress, enhanced social interaction, and increased job satisfaction. Limitations: This study was conducted at two long-term care communities within a single care provider in Australia, which may limit the transferability of our findings to other settings. Implications: These findings could inform multi-component interventions combining targeted training, clear communication policies, environmental adjustments, and ongoing organisational support that are required to enhance staff communication practices, improve communication with residents, foster meaningful social interaction, improve care delivery, improve residents’ mental health and quality of life, and create a supportive work environment.
Context: This article explores the organisation of social activities by care practitioners within residential care settings and examines how it influences their attentiveness towards older adults. The phenomenon is investigated in two private Finnish nursing homes that provide intensive service housing around the clock for older individuals who are unable to live independently at home. Objective: The study aims to analyse how care practitioners organise social programmes as a collaborative practice and how the division of labour, tools and technologies constrain the ability of care practitioners to act attentively during these events. Method: The ethnographic material comprises interviews, observations of work shifts, and reflections on filmed episodes from social activities within the two nursing homes. By integrating a framework derived from prior ethnographic studies with practice-based theory, the analysis examines how technologies, pre-existing tools, temporal rhythms, and the division of labour shape social activities. Findings: The study contributes to the discussion of relational care by conceptualising it as a practice-based sociomaterial activity. The analysis revealed that the organisation of social activities influences the capacity of care practitioners to perform care as a relational activity, encompassing ethical values such as attentiveness. Limitations: The ethnographic sample, drawn from the Finnish context, restricts the generalisability of the findings to other countries. Implications: Relational care cannot be achieved solely by enhancing the communication skills of nurses. Work communities should evaluate how the implementation of technologies, the division of labour, and pre-existing tools introduce new inequalities into social activities from the residents’ perspective. The developed framework may provide a set of potential evaluation criteria for care communities.
Context: There is limited evidence regarding the priorities of older people living in care homes to inform research activity. Objectives: This review aimed to identify research priorities from the perspective of residents, their relatives, community-dwelling older people, health/care professionals and care home staff. Methods: Included studies were from economically developed countries and designed to identify the research priorities of care home residents. Excluded studies described priorities relating to specific health conditions. Medline, Embase, PsycInfo, CINAHL were searched (January 2010–August 2024), alongside grey literature. Studies were assessed for quality but not excluded on this basis. A bespoke data extraction form was used, and content analysis undertaken to synthesise findings. Findings: Thirty-five reports were included. Study designs varied, including priority setting exercises, surveys, interviews, focus groups, literature reviews. Priorities – and unmet needs, where future research would be beneficial – were organised into themes: residents’ daily life; residents’ quality of life; health prevention, assessment and management; caring for residents; care home staff; health and care services. Limitations: Limiting the search to the English language might have excluded reports of relevance, but a large body of evidence from a wide range of countries was included. Priorities and un-met needs were included, as were reports that weren’t exclusive to care homes. This approach might have been insufficiently targeted; however, it increased resident representation in our findings. Implications: Review findings provide a valuable resource for researchers and health/care staff wishing to focus their research or service provision on areas of importance for care home residents.
