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

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.

Primary outcomes

• Older peoples' rating of Person-centered care [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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.
• Staff-rated person-centered care [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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.

Secondary outcomes

• Older peoples' rating of their health/wellbeing -EQ-VAS [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: Survey, scale for health EuroQol - (EQ)- VAS, scores 0-100, higher scores better health
• Older peoples' rating of their health/wellbeing - Life satisfaction [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: Survey, the Life Satisfaction Questionnaire with scores 0-100, higher scores a more desirable outcome for wellbeing
• Older peoples' rating of their health/wellbeing - Depression [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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"),
• Older peoples' rating of their health/wellbeing - Anxiety [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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").
• Older peoples' rating of their health/wellbeing - Loneliness [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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).
• Staff-rated quality of working life - Structural conditions/empowerment [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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).
• Staff-rated quality of working life - Thriving [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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.
• Staff-rated quality of working life - Stress symptoms [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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.
• Staff-rated quality of working life - Intention to leave [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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
• Staff-rated quality of working life - Job satisfaction [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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
• Staff-rated quality of working life - Psychological empowerment [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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.
• Staff-rated quality of working life - Work-life conflict [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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.
• Staff-rated quality of working life - Quantitative demands [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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.
• Staff-rated quality of working life - Emotional demands [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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.
• Staff-rated quality of working life - Burnout [Data collection before the changes (pre-), and thereafter 12 and 24 months after the first data collection (post data collection).]: 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.

Other outcomes

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

Sex: All, ages: 70 Years to any

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.