[SpitexPlus: assessment of and specialised nursing care for elderly and their families living in the community].

Current demographic developments and the high prevalence of chronic conditions require new approaches to nursing care of the elderly population in Switzerland. New care models need to be developed that go beyond traditional nursing practice with its focus on the individual. Existing preventive home visit and case management programmes have mostly focussed on the young old with the goal to maintain functional health and prevent institutionalisation. Families, who play a crucial role in the care of the elderly at home, were not included. The purpose of this article is to describe the development of the SpitexPlus Project, which is directed at people 80 years and older and their families, irrespective of their health status and social situation. It aims to improve self-care capabilities and quality of life in people 80+ and their families and to enable them to manage the challenges of daily life at home. Evidence based nursing interventions, based on the principles of health promotion, empowerment, family centeredness, and partnership were developed. The development of the programme phases, interventions, and the role of the advanced practice nurses are described in detail. Potential benefits for nursing practice are delineated.