Improving psychosocial well being of older persons in Belgian nursing homes: key levers from policy to practice - a targeted review and expert consensus from the Belgian Superior Health Council.

BACKGROUND: Belgian nursing homes increasingly care for residents with complex neurocognitive and psychiatric vulnerabilities, placing pressure on care systems structured around biomedical needs. Improving psychosocial well-being has therefore become a key quality of care challenge in long-term residential settings. METHODS: This article presents a narrative synthesis based on the multidisciplinary advisory process conducted within the Belgian Superior Health Council (SHC). Findings from a targeted literature review were integrated with expert consensus to examine organizational and care-related factors influencing psychosocial well-being in nursing homes. Evidence was analysed according to determinants operating at three interrelated levels: clinical (micro), organizational (meso) and policy (macro). RESULTS: Psychosocial well-being eresults from interacting mechanisms across multiple system levels. At the clinical level, person- and relationship-centred care, supported by non-pharmacological and personalized interventions, constitutes a key organizing principle. At the organizational level, staffing, leadership, training and multidisciplinary collaboration are critical enabling factors. At the policy level, the recognition of psychosocial and psychiatric complexity in financing, regulation and quality frameworks should facilitate implementation. Cross-cutting issues such as medication optimization and technological innovation, further highlight the need for coordinated action across levels. Overall, psychosocial well-being is influenced by determinants operating across multiple system levels and that coordinated multilevel strategies may offer a useful framework for addressing them. CONCLUSIONS: Improving psychosocial well-being in nursing homes requires a systemic and integrated approach linking policy , organizational conditions and clinical practices. A shift towards holistic, relationship-centred care is essential to support meaningful, dignified and connected lives for older persons.