Making nursing homes more community-oriented: insights from an exploratory study in Germany.

Nursing homes have been criticised for restricting the lifestyle of older people in need of care. As concepts of elder care have changed and services in formal care have developed further, efforts towards deinstitutionalisation have led to the enhancement of community care models. This paper discusses how ideas of community care can also influence reform within institutional care. The study focuses on the challenges and obstacles of practice change arising in German nursing homes by opening up to civil society principles. Applying the model of organisational hybridisation, the concept of 12 German nursing homes regarding family and community partners' involvement were analysed through explorative qualitative interviews with nursing home directors. The nursing homes have conceived various forms of co-operation with community actors. Nevertheless, emerging tensions between state, market and civil society conceptions of the nursing homes limit practical change. The ‘organisational hybridisation’ has generated two general problems to be discussed here: first, the difficulty nursing homes have in opening their doors to new perceptions of care as well as to the interests of their community partners. Second, the fact that the nursing homes tend either to strive for an integration in community life or for the maintenance of a ‘sheltered zone’ for their residents implies that nursing homes' definition of ‘normality’ has a strong influence on their chosen concept of care. [ABSTRACT FROM PUBLISHER]