Translating person-centered care into homecare practice: challenges and innovations in implementing dementia policy...

Despite strong commitments, translating person-centered and dementia care principles into practice remains challenging in homecare settings. In Sweden, national and regional frameworks such as Nära Vård (Good and Close Care) and the Sörmland Dementia Strategy promote autonomy, participation, and collaboration. Yet, their enactment unfolds within layered institutional systems characterized by multiple logics, documentation demands, and fragmented responsibilities, which often dilute the intent of person-centered policies. The study applied a policy enactment perspective to examine how person-centered and dementia-related policies are interpreted, negotiated, and translated into municipal homecare services. It further explores how participatory, design-driven methods can support policy enactment by providing structured arenas for collective sensemaking and resource negotiation across system levels.

A qualitative design was employed in the county of Sörmland, Sweden, combining 17 semi-structured interviews with policymakers, municipal managers, and homecare staff, and two participatory workshops (n = 14-18) involving actors ranging from frontline staff to managerial levels. Interview data was analyzed using inductive and abductive thematic analysis, while workshop data were examined using the framework method to identify shared interpretations and enactment conditions. Patient and Public Involvement (PPI) activities with people living with dementia and unpaid carers informed the design and validated the findings.

Findings show that policy enactment is constrained by fragmented organizational structures, limited prioritization of dementia, uneven (dementia-specific) knowledge across roles, workforce instability, time pressures, and weak feedback mechanisms. Documentation-heavy routines often reinforce biomedical notions of "good care," limiting the mobilization of relational, person- centered practices. Participatory workshops facilitated the development of provisional, middle-level interpretations that can help bridge abstract policy ideals and situated care practices.

Our study contributes by extending policy enactment frameworks into dementia homecare, and by illustrating how participatory approaches can strengthen bottom-up translation mechanisms within complex public care systems.