Nursing Homes in Norway: Their Changing Role in a Home-First Long-Term Care System

An older person enters a Norwegian nursing home today at a different point in their care journey from many residents a generation ago. They may have lived at home into their late eighties with home nursing, practical assistance, welfare technology and support from family. They may arrive after repeated falls, advancing dementia, complex medication, severe frailty or a hospital admission from which returning directly home is no longer realistic.

That shift is reshaping the place of nursing homes within the wider Norway Ageing, Long-Term Care & Community Support Knowledge Hub. Norway remains committed to helping older people live safely at home for as long as possible, but this does not make nursing homes less important. It changes what they are being asked to do.

Long-term places increasingly support people with substantial and often overlapping needs. Short-term places may provide rehabilitation, treatment, assessment, respite or palliative care. Municipalities therefore need nursing homes to function as part of a flexible continuum rather than as a single institutional endpoint.

The strategic question is no longer simply how many beds a municipality operates. It is whether institutional capacity, home-based care, housing, rehabilitation, workforce and specialist support are designed together around changing levels of need.

Nursing homes remain a municipal responsibility

Norwegian municipalities are responsible for ensuring necessary health and care services for people who need them. This includes home-based services, rehabilitation and nursing-home care.

Access to a nursing-home place is therefore determined locally through an assessment of need rather than through a separate national long-term care insurance entitlement.

An individual or relative can apply to the municipality, and the municipality assesses what form of support is appropriate. A nursing-home place may be offered where the person needs substantial care, treatment or supervision that cannot reasonably be met through a less intensive arrangement.

The important distinction is that a nursing home is not simply housing with services attached.

In an omsorgsbolig, or adapted care dwelling, the person normally has their own tenancy or ownership arrangement and receives home-based services much as another person living in the community would. A nursing home is an institution providing integrated accommodation, health care and continuous care support.

That distinction affects funding, rights, user payments, staffing and the practical experience of the person living there.

Long-term and short-term places serve different purposes

Norwegian nursing homes perform at least two major functions.

Long-term stays are intended for people who need continuing care and supervision around the clock. There is no fixed upper limit on how long such a stay lasts. These residents are increasingly likely to have extensive assistance needs, dementia, frailty or several chronic conditions.

Short-term stays are more transitional. They can support rehabilitation and recovery after hospital treatment, assessment following deterioration, respite for relatives, treatment that does not require specialist hospital care or palliative support.

The distinction matters because the two forms of care require different operational models.

A long-term unit needs continuity, relationship-based care, meaningful activity, dementia competence and strong end-of-life capability. A short-term unit may need faster assessment, rehabilitation expertise, medical review, discharge planning and close coordination with home-care services.

Trying to run both as though they are identical beds can weaken both functions.

The national numbers show a changing pattern

Norway had just under 40,000 nursing-home beds at the end of 2025. The overall number had changed relatively little over the preceding years even as the older population continued to grow.

At the same time, the pattern of use has shifted.

Long-term institutional stays numbered just over 30,000 at the end of 2025 and had declined compared with 2021. Short-term stays had increased over the same period.

The profile of residents also illustrates increasing complexity. Among long-term institutional residents whose level of assistance need was recorded in 2025, the overwhelming majority had extensive need for assistance.

This is a critical point.

A relatively stable bed base does not mean the role of institutional care is static. It can instead mean that entry occurs later, after more support has already been delivered at home, leaving nursing homes with a more complex resident population.

This is one reason why quality and governance in older people’s care become more demanding even when bed numbers themselves do not rise dramatically.

Home-first policy changes the institutional case mix

Norway’s Bo trygt hjemme reform strengthens the policy ambition that older people should be able to live safely at home for longer.

The logic is compelling. Most people prefer to remain in familiar surroundings, institutional care is resource intensive, and many needs can be met more effectively through prevention, rehabilitation, better housing and home-based services.

But a home-first strategy does not eliminate high-dependency care.

It concentrates it.

If people enter nursing homes later in the trajectory of frailty, dementia or multimorbidity, institutions increasingly support residents who need more clinical oversight, more assistance with everyday activities and more complex decision-making.

This creates a different workforce requirement from a model in which institutional care houses a broader mix of relatively independent and highly dependent residents.

It also changes the relationship between nursing homes and hospitals. Municipal institutions may increasingly absorb people who no longer need specialist hospital treatment but still require intensive nursing, rehabilitation, observation or palliative care.

Scenario: the nursing-home application comes after years of support at home

An 89-year-old woman with dementia lives alone in an adapted apartment. For several years she has received municipal home nursing, practical assistance and meals support. Her daughter visits several times each week.

Over time, the woman begins leaving the apartment at night, missing medication and forgetting whether she has eaten. Additional home visits and welfare technology are introduced. For a period, these measures allow her to remain at home safely.

The position changes after several falls and an episode of delirium. She now needs repeated assistance throughout the night and can no longer reliably summon help.

The municipality reassesses the situation with the woman and her daughter. The question is not whether every possible home-care intervention has literally been exhausted. It is whether the package required to keep her at home remains safe, proportionate and consistent with her wellbeing.

A long-term nursing-home place is offered in a dementia-adapted unit.

The move is therefore not evidence that ageing-at-home policy has failed. It is the point at which the balance of need has changed.

For municipal planning, this distinction is essential. Home-first systems still need sufficient institutional capacity for people whose needs eventually exceed what dispersed home support can safely provide.

Nursing homes increasingly need stronger clinical capability

Residents entering nursing homes later in life are more likely to live with multimorbidity, polypharmacy, mobility impairment, cognitive decline and palliative needs.

This raises the clinical intensity of everyday care.

Staff may need to monitor chronic conditions, identify acute deterioration, manage complex medication, prevent pressure injury, assess nutrition, support continence, recognise delirium and distinguish reversible illness from end-of-life decline.

Medical oversight is also important. Nursing-home doctors must work alongside nurses and other staff to review treatment, respond to deterioration and make proportionate decisions about hospital transfer.

A clinically stronger nursing home can sometimes avoid unnecessary hospital admission by treating manageable deterioration locally. But this requires competence, access to medical advice, appropriate equipment and clarity about the limits of municipal care.

The objective is not to turn nursing homes into hospitals.

It is to ensure they have enough clinical capability for the people who now live in them.

Dementia increasingly defines institutional care

Dementia is central to the future of Norwegian nursing homes because many people with advanced cognitive impairment eventually require continuous supervision and support.

Long-term care therefore needs much more than secure accommodation.

Good dementia care depends on staff understanding communication, distress, life history, environment, sensory needs, routines and meaningful activity.

It also requires close attention to restrictive practice. A locked door, bed rail or movement restriction may appear protective but can have significant consequences for autonomy and dignity.

The relevant standard is not risk elimination. It is proportionate, individualised support that protects safety while preserving as much agency as possible.

This connects directly with person-centred dementia planning and with the wider expectation that institutional care should remain a home, not simply a place where clinical tasks are completed.

Short-term places are becoming strategically important

Short-term nursing-home capacity sits at the interface between hospitals, home-based care and long-term institutional care.

A short-term stay may allow an older person to recover strength after hospitalisation before returning home. It may provide observation where the appropriate long-term support level is uncertain. It may also prevent a permanent move into institutional care by giving rehabilitation time to work.

This makes short-term beds important for system flow.

But their value depends on active purpose.

A bed described as rehabilitation but used mainly for passive waiting does not deliver the same outcome as a structured programme with clear functional goals, therapy input and discharge planning.

Likewise, short-term stays can become longer than intended if suitable home support, equipment or adapted housing is not available.

The strongest model therefore links admission to a clear question: what needs to happen during this stay, and what is the likely next destination?

That is closely related to hospital discharge and reablement, because the nursing-home bed should support recovery rather than become an unintended holding point between sectors.

Scenario: a short-term bed becomes a rehabilitation bridge

An 84-year-old man is discharged from hospital after treatment for pneumonia. Before admission he lived independently with a weekly home-care visit, but after ten days in hospital he cannot manage stairs safely and needs assistance with dressing.

He is medically ready to leave hospital but not yet ready to return home.

The municipality allocates a short-term nursing-home place. On admission, the team establishes specific goals: walking independently with an aid, managing transfers, preparing a simple meal and rebuilding confidence on stairs.

Physiotherapy and occupational therapy are integrated with ordinary nursing support rather than added as occasional separate interventions. His medication is reviewed and nutritional intake monitored because weight loss is slowing recovery.

After three weeks, he returns home with a temporary increase in municipal support.

The short-term stay has therefore performed a distinct system function. It has prevented hospital beds being used for rehabilitation that can be provided locally, while avoiding premature long-term institutionalisation.

For municipalities, the lesson is that short-term capacity must be governed by outcome and flow. Occupancy alone is insufficient. Leaders need to know whether residents are recovering, returning home, moving to appropriate longer-term care or repeatedly cycling through short stays without resolution.

Funding reinforces the distinction between home and institution

Norwegian municipal care is largely tax funded, but the financial experience of the individual differs between settings.

Healthcare delivered in the home, including home nursing, is generally provided without user charges for the health component, although charges may apply to some practical assistance.

Institutional stays operate differently. Municipalities may charge user payments under national rules. Long-term payments are linked to income, while nationally regulated maximum charges also apply to short-term stays.

This matters for both people and municipalities.

A nursing-home place brings accommodation, meals, care and health services together within one institutional arrangement. An adapted care dwelling remains the person’s home, with housing costs and separately allocated home-based services.

The financing architecture therefore shapes how the boundary between housing and care is understood.

Municipal decision-making should still be based on need rather than on which arrangement appears financially preferable to one part of the system.

For the individual and family, clear explanation is essential because the move into institutional care can change both daily life and personal financial arrangements at the same time.

Workforce sustainability will determine what nursing homes can safely do

Norway’s nursing homes are highly dependent on the wider municipal health and care workforce.

The national workforce challenge is becoming more significant as the number of older people requiring complex care grows while the working-age population expands more slowly in many areas.

Nursing homes cannot respond simply by increasing staffing ratios indefinitely.

They need a deliberate skill mix.

Registered nurses may need to focus increasingly on clinical assessment, medication, deterioration and complex care planning. Health care workers can provide substantial skilled direct care. Physiotherapists, occupational therapists, physicians and other professionals may need to work more flexibly across institutional and home-based services.

Task-sharing can help where responsibilities are clear and staff competence matches the task.

But workforce redesign should not remove professional judgement from the points where it matters most.

The older people’s workforce and skill-mix challenge is therefore about capability as much as headcount.

Organisations examining comparable pressures can use the Digital Twin Scenario Modeller to test how changes in demand, staffing and service capacity could interact. It is not a Norwegian workforce-planning instrument, but it provides a structured way to examine assumptions before redesign decisions are made.

Quality cannot be judged through staffing or occupancy alone

Nursing-home quality is multidimensional.

A full bed does not demonstrate good care. Neither does a favourable staffing figure on its own.

Quality needs to be visible in clinical processes, resident experience, safety, dignity and outcomes.

National Norwegian indicators increasingly help expose variation in areas such as medication review, nutrition, medical assessment and oral health.

Recent data show why this matters. In 2025, only around six in ten long-term nursing-home residents aged 67 and over were recorded as having received a medication review during the previous year. The proportion varied markedly between counties.

Nutrition shows a similar pattern. Around six in ten long-term institutional residents aged 67 and over were recorded as having been assessed for undernutrition risk in 2025. More than one-third of those assessed were identified as being at risk, yet not all had an individual nutrition plan.

These figures need careful interpretation because registration and data quality vary. They should not be treated as a complete judgement on service quality.

But variation itself is a governance signal.

It tells national and municipal leaders where practice, documentation or data systems require closer examination.

Medication governance becomes more important as residents become more complex

Polypharmacy is common among nursing-home residents because many live with several chronic conditions.

Annual medication review for older long-term residents therefore plays an important role in reducing avoidable harm.

The purpose is not simply to verify that every medicine has once been prescribed appropriately.

It is to reconsider whether the complete medication regimen still reflects the resident’s current condition, goals, risks and life expectancy.

A medicine that was reasonable five years earlier may now contribute to falls, low blood pressure, sedation, confusion or swallowing burden.

Strong review processes also become essential after hospital treatment, where prescriptions may have changed across multiple services.

The governance challenge is ownership. Someone must be able to reconcile what was prescribed before admission, what changed in hospital, what the nursing home is administering and whether the resident is experiencing adverse effects.

This connects with medicines, frailty and safety in later life, because medication cannot be separated from mobility, cognition and function.

Nutrition and oral health reveal whether basic care remains visible

As clinical complexity increases, nursing homes must avoid allowing everyday fundamentals to become secondary.

Nutrition is a good example.

An older resident may eat poorly because of dementia, depression, swallowing difficulty, poor dentition, medication side effects or simply because mealtimes no longer reflect familiar preferences.

Weight loss can then worsen weakness, infection risk, falls and pressure injury.

Oral health is closely connected. Residents who have lived in a nursing home for sufficient time have rights to necessary public dental care, yet national figures continue to show substantial variation in whether assessments are recorded.

These are not minor comfort issues.

They demonstrate whether a service is able to maintain the whole person while managing increasing clinical dependency.

Scenario: recurring weight loss becomes a governance issue

A long-term nursing-home unit notices that several residents have lost weight over three months.

Each case initially appears different. One person has dementia and often leaves the dining room. Another has recently returned from hospital. A third has poor-fitting dentures.

If each episode is managed independently, the service may miss the common organisational factors.

The unit reviews its nutrition data and identifies that risk assessments are inconsistent, individual plans are not always updated after deterioration and communication with dental services has been slow.

The response therefore operates at two levels.

Individual residents receive review of food preferences, medication, swallowing, oral health and meal support. At the same time, the nursing home changes its system for nutrition screening, post-hospital review and escalation of sustained weight loss.

The example illustrates the difference between care delivery and governance. Good staff can respond compassionately to individual residents, but governance determines whether repeated patterns lead to improvement across the service.

The Quality Dashboard Builder can help organisations structure comparable evidence across quality, safety and outcomes, while remaining separate from Norway’s own statutory reporting and quality-indicator arrangements.

Digital infrastructure is becoming part of safe institutional care

Nursing homes increasingly depend on access to accurate digital information.

Residents move between hospitals, general practice, emergency services and municipal care. Every transition creates a risk that medication, diagnoses, advance decisions or recent treatment are not visible to the next team.

From 2026, municipalities are required to make the national core health record, Kjernejournal, available in nursing homes and home-based services.

This strengthens the potential for municipal staff to access critical health information when residents move between settings.

But access alone does not create interoperability.

Care still depends on staff knowing what information is current, which system holds the authoritative record and how new information should be reconciled with local documentation.

Digital transformation therefore needs to support clinical work rather than simply add another screen.

The Digital Transformation Readiness Assessment can help organisations examine similar questions about infrastructure, workforce adoption, governance and resilience without replacing Norwegian requirements or local technology governance.

Families remain partners after institutional admission

A move into nursing-home care changes family responsibility, but it does not remove the importance of family relationships.

Relatives often hold knowledge that improves person-centred care: routines, cultural preferences, communication patterns, significant life events and subtle signs of distress.

They may also provide companionship and continuity that formal services cannot reproduce.

Yet nursing-home admission should normally reduce rather than preserve an unsustainable level of unpaid care.

A spouse who has been providing night-time supervision for years should not be treated as though the same responsibility simply continues inside the institution.

Partnership therefore requires clarity.

Families should be involved in decisions where appropriate, listened to when they raise concerns and supported to maintain meaningful relationships. But responsibility for safe institutional care remains with the municipality and service.

This reflects the wider principle of family partnership and carer support without confusing partnership with substitution for paid care.

Palliative care is increasingly part of ordinary nursing-home competence

For many residents, the nursing home becomes their final home.

That makes palliative and end-of-life capability a core part of institutional quality rather than a specialist add-on.

Staff need to recognise when the goals of care are changing, manage pain and other symptoms, communicate with families and support decisions about whether hospital transfer would offer meaningful benefit.

Advance planning can reduce uncertainty during deterioration.

A resident with severe frailty and advanced dementia may benefit more from skilled symptom management in familiar surroundings than from repeated emergency transfer, but that judgement must be individual and clinically grounded.

Equally, institutional residence must never become a reason to withhold treatment that could provide genuine benefit.

The central principle is proportionality.

This connects nursing-home practice with end-of-life and advance care planning, where residents’ values, clinical judgement and family communication need to be aligned before crisis decisions arise.

Scenario: avoiding an unnecessary final hospital transfer

A 91-year-old man with advanced heart failure, severe frailty and dementia has lived in a nursing home for two years.

He develops another chest infection. His oxygen level falls and he becomes more sleepy.

In earlier years he was routinely transferred to hospital during similar episodes. More recently, his doctor, nursing staff, family and the resident himself, while he was still able to participate clearly, had discussed what future deterioration might mean.

The agreed care plan prioritises comfort where recovery is unlikely and avoids hospital transfer unless there is a realistic treatment benefit that cannot be provided in the nursing home.

The nursing-home doctor reviews him. Staff commence treatment and symptom relief that can safely be provided locally. His family is contacted and kept informed.

His condition worsens and he dies peacefully several days later in familiar surroundings.

The governance strength in this scenario is not that hospital transfer was avoided at all costs. It is that the decision was anticipated, personalised, clinically reviewed and visible to everyone involved.

Without prior planning, the default response might have been emergency transfer simply because uncertainty was highest at the moment when the resident was least able to express his wishes.

Municipal variation makes local governance critical

Norway combines national rights and standards with substantial municipal responsibility for how care is organised.

This creates flexibility but also variation.

A large urban municipality may operate specialised dementia units, rehabilitation centres and dedicated palliative teams. A smaller rural municipality may need one institution to perform several functions with access to specialist support from elsewhere.

The appropriate model therefore cannot be identical everywhere.

But the governance questions should remain recognisable.

• Are short-term beds achieving rehabilitation and discharge outcomes rather than simply absorbing pressure?
• Are long-term residents receiving sufficiently skilled clinical and person-centred care?
• Are medication, nutrition and oral-health risks being identified and acted upon?
• Does the workforce skill mix match resident complexity?
• Are repeated hospital transfers, falls and deterioration reviewed for patterns?
• Can residents and families influence service improvement?

Organisations examining similar accountability questions can use the Governance Maturity Assessment to structure reflection on oversight, escalation and evidence. It is not a Norwegian regulatory framework, but its underlying purpose is relevant wherever responsibility is distributed across complex services.

The future is a continuum, not a contest between home and institution

Public discussion about long-term care can sometimes imply that home care and nursing homes are competing models.

That is increasingly the wrong way to frame Norway’s choices.

A sustainable system needs both.

Some people can remain at home for substantially longer when housing is adapted, home-based services are responsive and rehabilitation prevents avoidable decline.

Others will eventually require continuous support that is more safely or effectively provided in an institution.

The policy challenge is therefore to create movement between levels of care without treating any one setting as inherently superior.

Short-term nursing-home care can support a return home. Long-term care can provide security when home care is no longer sufficient. Adapted housing can sit between the two. Welfare technology can strengthen several settings rather than replace them.

This is why municipal planning needs to look across the whole care pathway rather than optimise each component independently.

What international systems can learn from Norway’s direction

Norway’s institutional arrangements are shaped by municipal responsibility, tax-funded services and a relatively strong public welfare model. Those features are not directly transferable to every country.

The broader lesson is more useful.

As home-based care expands, residential care does not necessarily disappear. Its role becomes more concentrated around high complexity, transition, rehabilitation, dementia and end-of-life care.

Other systems therefore need to avoid assuming that successful ageing-at-home policy automatically reduces the need for investment in institutions.

It may instead require a different kind of institution: smaller in relative reach but more clinically capable, better connected to hospitals and community services and more clearly differentiated between short-term and permanent functions.

The transferable principle lies in designing the continuum as a whole.

Conclusion

Norway’s nursing homes are being reshaped by the same policy direction that seeks to keep older people at home for longer.

As home-based services, adapted housing, rehabilitation and welfare technology support people further into later life, those who eventually enter institutional care are increasingly likely to have extensive, complex and clinically demanding needs. Nursing homes therefore remain essential, but their role is becoming more specialised.

Long-term units need stronger dementia, multimorbidity, medication and palliative capability. Short-term places need to function as active bridges between hospital, rehabilitation and home rather than as passive holding capacity. Across both, municipalities need evidence that quality, nutrition, oral health, clinical review, workforce competence and resident experience are visible and improving.

The central planning challenge is not to choose between nursing homes and ageing at home. It is to connect them.

A sustainable Norwegian long-term care system will need institutional care that is proportionate to need, sufficiently skilled for increasing complexity and integrated with the wider municipal and specialist health system. When that connection works, nursing homes become neither the automatic destination of old age nor a residual service of last resort. They become a deliberately designed part of a continuum that supports independence where possible and intensive care where necessary.