Aim: In order to improve patient outcomes and minimize health care costs, many Western countries are attempting to reduce the length of stay in hospitals by transferring responsibilities from specialist care to primary care. In Norway, the Coordination Reform was implemented in 2012 to enhance this development. As a result, the number of patients discharged to the municipal health care services has increased significantly. We investigate the extent to which nurses in nursing homes and home care services feel equipped to provide adequate care for patients discharged from hospitals after the reform.Data: Altogether, 1,938 nurses representing around 80% of Norwegian municipalities assessed their experiences of this reform.Results: An increase in the number of poorly functioning patients discharged to the municipality services was reported. Regardless of place of work, concerns were raised about limited resources in terms of personnel, equipment and competence, as well as an increase in hospital readmission rates. Negative reports on care provision for recently discharged patients came most frequently from nurses in municipalities which generally had low incomes, diverted limited resources to the health care sector and relied heavily on home-based care.Conclusion: Insufficient transfer of resources to the home care services may have hampered the ability to fulfil the Coordination Reform’s intentions of providing safe care to patients in their own homes as an alternative to prolonged hospital stays. Due to a marked increase in reported hospital readmissions, it is not obvious that shorter lengths of stays have reduced overall health care costs.

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Aims This study investigates the prevalence of nurses’ wishes to leave work in elderly care services and aims to explain differences between younger and older nurses. Background Health‐and‐care services, and specifically elderly care services, experience problems recruiting and retaining nurses. Method A nationwide survey among nurses in Norway with 4,945 nurses aged 20–73 (mean age = 41.8), 95% female. Structural equation modelling was used, analysing the whole sample as well as analysing younger and older nurses as separate groups. Results Of the nurses surveyed, 25% wanted to work outside elderly care services and 25% were uncertain. The wish to leave was much more frequent among younger nurses. Reported working conditions were a strong predictor of the wish to leave, and a much stronger predictor among younger nurses than older nurses in nursing homes. Conclusions Working conditions are a major predictor of nurses’ wishes to leave elderly care services, especially among younger nurses in nursing homes. Implications for Nursing Management Attempts to reduce turnover in elderly care services need to address the working conditions for younger nurses, for instance by reducing the time young nurses work in isolation.

Paid sick leaves for caregivers that are employed, and hospital-at-home programmes that provide education and surveillance to the patient and his/her family through different phases of the illness, are policy means that both can help the informal caregivers to manage daily life and reduce the pressure on the formal healthcare and long-term care services in the future.

care services: Do the oldest users lose out?Population ageing is a major concern in most European countries. Demands for health-and care services will increase, as older people typically have a higher need for such services. What is often overlooked, however, is that older users increasingly compete with younger users for the same limited care resources. We ask: How do employees in the Norwegian care sector make decisions regarding the allocation of services to younger and older users? To answer this question, we interviewed decision-makers in Norwegian municipalities. Despite providing for equal rights to services, laws allow for an interpretation of needs and this can result in the unequal distribution of services. Our study indicates that needs are defined differently for younger and older users, which affects the amount, type and content of the services allocated to younger and older people. When resources are scarce and priorities must be established, the services to the oldest suffer. Key Practitioner Message: • The article lays the groundwork for an open debate about the allocation of resources to users in different life phases; • The analysis conceptualises and makes explicit important normative decisions made by practitioners.