Today, the average age of the human population worldwide is rising rapidly.1 The number of older people, i.e. aged 65 years and older, is estimated to be 1.2 billion in 2025, increasing to 1.9 billion in 2050.2 Approximately 92% of the independently living older people want to remain in their current residence as active and maintain a good quality of life.3,4 With ageing, the prevalence of chronic diseases and disabilities in older people is increasing.5 Therefore, an increase in functional decline and often deterioration in multiple health domains, such as psychological and social problems, arise.5 As a result, the demand for home care will grow alongside increasing costs.6

In many countries, home care is organized and funded differently.7 Home care can be defined as formal nursing services and personal care provided by care providers in patients’ own homes.7 In the Netherlands, home care includes personal, psychosocial, and technical nursing care delivered by registered nurses, nursing assistants, and specially trained nurses.7,8 These care providers deliver different types of care to various types of patients, such as chronically ill people, disabled people, older people, and people at the end of life.7,9 Home care encompasses both long-term and short-term care provided at home, for instance, after discharge from the hospital.7,9

Nowadays, home care primarily focuses on improving and strengthening the self-reliance and self-management of older people.10 ‘Empowering’ older people needing home care and strengthening their self-reliance aligns with the new definition of Health, known as Positive Health, which has been embraced by the World Health Organization (WHO).11,12 International experts developed Positive Health during an invitational conference and defines health as "the ability to adapt and self-manage in the face of social, emotional, and physical challenges of life".11 Compared to the traditional WHO definition, Positive Health describes health as a dynamic continuum, determined by factors such as functionality, resilience, and self-direction, rather than a static endpoint.12 This definition emphasizes that people can achieve or maintain good health, even when experiencing an illness.11 By embracing this definition, the WHO can contribute to promoting a healthier and more sustainable society for all individuals. While there is no predefined method for applying the Positive Health concept in clinical practice, it demands a shift in how patients and caregivers are perceived. Positive Health involves engaging in different types of conversations between patients and caregivers, as well as embracing shared decision-making with patients.11, 12 Currently, evidence has yet to be reported on how to apply Positive Health in home care and what the impact is on patient outcomes. However, strengthening the autonomy of the older people living at home showed their effects.

Several studies showed that older people who receive home care value making autonomous decisions and maintaining their autonomy despite their dependency.13,14 Furthermore, a study reported that patients who have learned to manage their life better and to cope with their disease, experienced improved health, less distress, less loneliness, fewer emergency department visits, and fewer perceived disabilities and limitations in social activities.4 These results also showed that managing their own lives positively influences patients’ outcomes and decreases the demand for home care, e.g., patient satisfaction, quality of care, amount, and duration of home care.4,15,16 Thereby, evidence regarding patients with a chronic disease who live at home has shown that people who can successfully adapt to an illness are also able to work or participate in social activities and feel healthy despite their illness-related limitations.11

Currently, there needs to be more evidence on the impact of the introduction of Positive Health, in terms of health care consumption, in a home care setting. To the best of our knowledge, no other studies have been reported on how the introduction of Positive Health influences the amount of home care received by older people living at home. This study aims to explore the influence of the introduction of Positive Health on the amount of home care nursing (in minutes per week) among home care patients within a period of six weeks.