Contested spaces. Exploring how policy and practice shape Norwegian nursing homes.

Nursing homes are intended as places of care, comfort, relief, and safety, yet they are highly contested spaces, caught in the middle between medical treatment and social care. Although nursing homes are created more home like they are rarely a first choice of residence for any individual. Still, they are of vital importance for the most vulnerable old and for families facing heavy care burdens. This project aim to explore how nursing homes are shaped by modes of governance "from above" and by capacity building "from below". Drawing on ethnographic data from nine Norwegian nursing homes located in three major cities, we explore how efforts to enhance the individuals sense of self is put into practice. Whereas nursing home ethnography has for decades been preoccupied with uncovering and highlighting the adverse and dysfunctional sides of long-term care institutions, we argue that more attention should be paid to promising practices and how these practices are generated. Why are some nursing homes perceived to be better places than others? We find that promising practices are evident in the practical work of shaping social situations, prompting the narratives of residents, assisting in the maintenance of their physical appearance etc. Sufficient or appropriate forms of attentiveness to residents? selves is a matter of finding the right balance between intervening too much or too little in resident's production of their physical or social appearance. This balancing act is highly contingent upon both the conditions of work and the culture of care in different institutional settings.

In light of the demographic trend towards an aging population, Norwegian local governments are facing great challenges in building and operating residential care facilities for the frailest elderly. The government calls for innovative solutions stressing health-promoting architecture/design and collaborative governance. In this project we aim to identify physical features and organizational approaches that offer the most promising practice in terms of providing care for frail elderly who live in nursing homes in a way that takes into consideration the every day needs and reality of both residents and staff. Nursing homes are studied from a top down and bottom up approach: We explore how and to what extent innovative ideas are hampered or enhanced by the complex system of multi-level governance. How are contemporary ideals on nursing homes manifested in new buildings and modes of governance and how are good ideas negotiated, adapted and modified as they materialize in an every day context? Furthermore we explore how nursing homes are experienced by different stakeholder using the space - by people who live there, work there and have a close family member living there. What aspects are included in their notions of a nice place? What role do physical/spat ial aspects play in creating a balance between sociability and privacy; between activity and safety? The study is a multi layered case study based on information rich illuminative cases of (1) cutting edge newly built nursing homes (2) traditional nursin g homes commonly agreed to be good places and (3) traditional/below average nursing homes. The study consists of layers of possible analysis. Data collection from each layer will be based on mixed methods (document analysis, focus group interviews, obser vations, semi-structured interviews). The veracity and validity of analysis will also be underpinned by triangulation of sources, analysts and theory perspective.