Specialist eldercare for people with substance abuse and complex needs: Promising practices or institutionalized ageism?

Increasing numbers of people age with substance abuse and complex needs, yet research is scarce. Existing studies have focused on users’ problems or the gaps in standard treatment provision and eldercare. The proposed project will do the opposite, investigating promising eldercare arrangements for people with substance abuse and complex needs. These provide care with a ‘for life’ approach according to three different models: entire nursing homes, specialist units within general nursing homes, and specialist home-care teams. The goal of care is not sobriety but harm reduction, and users are accepted as being active in their abuse. Such specialist care arrangements have been celebrated as humane, realistic solutions, but also criticized for being ageist by giving up on older people.Moving beyond this black-and-white view, the project will study promising care practices for older persons with substance abuse and complex needs. What are the reasons for providing individuals with this type of care? How are official goals of eldercare—dignity and well-being—accomplished? What are the advantages and risks of ‘for life’ care for those with addiction and complex needs? And above all, what are the experiences and views of service users? 
Comprehensive studies will be conducted of specialist nursing homes, specialist nursing home units, and specialist home care. Data from these distinct three studies will be collected at a total of 8 units, comprising 60 qualitative interviews with users, 18 group interviews with staff members, 28 interviews with case managers, and additional ethnographic data collected by participant observation. The project will contribute pioneering knowledge of care arrangements that have the potential to provide a vulnerable population with a better life.
The project was developed from studies that was funded by Systembolagets alkoholforskningsråd (Dnr: 2018:0020) 2018-2019. 
Project funding: FORTE (Dnr: 2019-01149) 4 660 000 SEK. Time of project: May 2019 – April 2021.
Ethical approval: Decision by the Swedish Ethical Review Authority 2019-10-28 Dnr: 2019-04404 (also Regional Ethical Vetting Board Lund 2018-12-12, Dnr: 2028/988).