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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 arrangements will 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.

Research output

Journal articles

Jönson, H., Højgaard-Bøytler, J. & Harnett, T. (2021). Finding a fair deal: Policies on alcohol and drugs at “wet” eldercare facilities. Journal of Substance Abuse Treatment.

Harnett, T., & Jönson, H. (2021). Enabling positive framings of stigmatised settings: a neglected responsibility for social work. European Journal of Social Work, 1-12.

Harnett, T., & Jönson, H. (2020). ‘Wet’ eldercare facilities: three strategies on the use of alcohol and illicit substances. Nordic Social Work Research, 1-14.

Jönson, H. & Harnett, T. (2019). Out of the ordinary: Media presentations on wet eldercare facilities. Nordic Studies on Alcohol and Drugs, 1-14.

Research reports

Jönson, H. & Harnett, T. (2023). Specialiserade boenden för äldre med långvarig missbruksproblematik: Lärdomar, utmaningar och rekommendationer [Specialized facilities for older people with long-term substance use problems: Knowledge, challenges and recommendations]. Research Report in Social Work: 2023:7, Socialhögskolan

Jönson, H. Germundsson, N. & Harnett, T. (2019). Hemtjänstmottagare med missbruksproblem – Förekomst, erfarenheter, svårigheter [Older home care users with substance use problems: Prevalence, experiences, challenges]. Research Report in Social Work: 2019:11, Socialhögskolan.

Conference presentations

Wet eldercare facilities for older persons with substance abuse problems and complex needs – promising care practices or institutionalized ageism? Håkan Jönson & Tove Harnett. Paper presented at 4th Transforming Care Conference, Copenhagen, June 24-26 2019.

Wet eldercare facilities for older persons with substance abuse problems and complex needs. Tove Harnett & Håkan Jönson. Presentation at “Meeting the Dragon” (conference on dual diagnosis, Copenhagen, 6-7 June 2019.

Lågtröskelboenden för äldre missbrukare: tre sätt att förhålla sig till alkohol och droger. Håkan Jönson & Tove Harnett. Presentation at FORSA-symposium, Norrköping March 12-13 2019.

Wet facilities for older persons: First findings from Sweden and Denmark. Tove Harnett & Håkan Jönson. Presentation at ESA Mid-term conference RN01, Brno, September 5-7 2019.

Cheers Lads! Nursing Homes for Older People with Substance Use Disorder in Swedish Print Media. Håkan Jönson & Tove Harnett. Poster presented at 25th Nordic Congress of Gerontology, May 23-25 2019.


Håkan Jönson, Professor
Tove Harnett, Senior lecturer
Jeanne Højgaard-Bøytler, Doctoral student

Project funding

FORTE (Dnr: 2019-01149) 4 660 000 SEK.
Time of project: May 2019 – April 2022

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: 2018/988).