Frontline providers' perspectives on ageing in place: negotiating older adults' self-responsibility, preventive services and community support.

backgroundAgeing in place implies that older adults remain in their own homes while maintaining autonomy and identity. Municipal health and social care services, which constitute the core of community-based primary care for older adults in Norway, are central to implementing ageing-in-place policies, yet frontline providers face resource constraints, fragmented services, and growing demands that shape how policies are translated into practice. This study explored frontline primary care providers' perspectives on how municipal health and social care services can support ageing in place and developed practice-based insights into how older adults' self-responsibility, preventive services and community support are negotiated in everyday work.

methodsA qualitative interpretive design informed by critical realism and Lipsky's street-level bureaucracy theory was employed. Eight focus groups were conducted with 38 frontline providers (nurses, nursing assistants, occupational and physical therapists, social workers, case managers, and a physician) across four Norwegian municipalities/urban districts with diverse profiles. Data were analysed using reflexive thematic analysis.

resultsThree main themes were identified: (i) Defining responsibility: supporting ageing preparation and managing expectations - providers described a growing gap between expectations and available resources, increased reliance on families, and the need for clearer communication and ageing-preparation counselling, with task shifting and selective use of welfare technology as ways to manage demand; (ii) Cultivating a culture of prevention: early detection, independence, and rehabilitation - despite policy emphasis on prevention, practice remained largely reactive, with limited protected time for intervention, falls prevention, and rehabilitation; (iii) Building inclusive communities: housing facilities, accessibility, and collaboration - providers underscored the importance of accessible housing, home adaptations, transport, and better coordination of social activities and volunteers to reduce isolation and support autonomy.

conclusionFrontline providers described how tight budgets and municipal autonomy favour reactive, legally mandated services over preventive and social support. They pointed to needs for operationalised prioritisation (e.g. simple decision tools), protected time for preventive work, selective use of technology and task shifting, early home adaptations, reliable transport, and navigation and social support. Cross-sector collaboration and sustained support to carers and frontline staff are essential to ensure equitable access and maintain older adults' independence and dignity at home.