Author
BILLINGS Jenny; LEICHSENRING Kai, eds.
Title
Integrating health and social care services for older persons: evidence from nine European countries.
Publisher
Ashgate, 2005
Summary
Providing Integrated Health and Social Care for Older Persons (PROCARE) is a project in the EU Fifth Framework Programme (Quality of Life and Management of Living Resources, Area 'The Ageing Population and Disabilities') which aims to help in defining the new concept of an integrated health and social care for older persons in need of care by comparing and evaluating different modes of care delivery. This volume draws on the achievements of the second project phase (2003-2004) that consisted of empirical fieldwork and a cross-national analysis of model ways of working in the nine participating EU Member States (Austria, Denmark, Finland, France, Germany, Greece, Italy, the Netherlands and the UK).
Contents
The book underpins the more general national and European considerations gathered in the project with empirical findings analyzed from a trans-national perspective. Its chapters have been written by 'internationally mixed' teams and will thus contribute to the development of a truly European perspective, providing: a general overview of European approaches to integrated social and health care services and policies that are to be developed to face the growing need for care in ageing societies; indicators for successful approaches and models of good practice to overcome the 'social-health-divide'; better understanding of the meaning of integrated services and the coordination of social and health systems in the different countries; facts and figures about coordination at the interface between health and social care for older persons; and problems and solutions ('lessons to learn') concerning regulation and coordination. A preface explains that the book concludes an important piece on integrated care for older people in Europe, pulling together different integrated care perspectives identifying the ways of approaching this type of care provision, providing evidence from the nine countries and demonstrating that comparative social research in Europe is progressing, despite the backdrop of restricted resources witnessed in recent times. An introduction, 'Moments of truth: an overview of pathways to integration and better quality in long-term care' by Kai Leichsenring, begins by defining and outlining integrated care, going on to describe the aims and achievements of PROCARE, giving an overview of 18 model ways of working, and describing policies and research to promote integrated care in Europe, ending with a summary of the book. Jenny Billings then discusses methodology in 'Towards rigour: a methodological approach to empirical research on model ways of providing integrating care'. In Chapter 1 Jenny Billings and Maili Malin explore the relationship between co-ordination and integration efforts in long-term care and the search for common definitions. They illustrate the common approach by discussing various definitions of integrated care from different stakeholders' perspectives, emphasising that staff perceptions of policy doctrines show a positive and common understanding, implying that staff and policy are at least in principle pulling in the same direction. Chapter 2, by Francesca Ceruzzi, Klaas Gorter and Laura Maratou-Alipranti, deals with a decisive 'moment of truth' in integrating health and social care, the access process, concluding that relevant procedure should be comprehensive, to cover the clients' needs for health and social care, understandable for clients, and manageable for stakeholders involved. It was found that improvements are ongoing, in particular with respect to joint working and real collaboration between agencies and different professionals. Chapter 3, by Kirstie Coxon, Thomas Clausen and Dominique Argoud, is explicitly dedicated to solutions in this area of inter-professional collaboration. In the future, major emphasis will have to be put on staff development strategies with respect to retrieval and retention of staff in the context of an increasingly pressing labour shortage in all industrialised countries. Co-ordination and integration processes should play a major role in upgrading existing staff, introducing new job profiles and career patterns as well as in the promotion of generally improved job conditions in long-term care. In Chapter 4, Natalia Alba, Giorgia Nesti and Steen Bengtsson outline some of the key innovations that have been linked to the development of co-ordination and integration in health and care services. These instruments and methods, however, are also dependent on organisational structures that allow for co-ordination and integration, and on professionals who are able to implement them in integrated care processes. The authors nevertheless show that similar instruments are used in the different models with respect to organisational development and quality management on one hand, and related to the care process on the other. In all European countries the family is taken for granted when it comes to care for an older relative, both by policies and most existing services. The challenge for integrated care delivery will thus be to develop choices and opportunity for family and 'informal' carers, who need to be considered as partners in a complex process with different responsibilities. Cecile Chartreau and others underline in Chapter 5 that still far too often even professionals in model ways of working abstain from integrating family carers in 'their' care processes for reasons (prejudices, complications, misunderstandings, etc.) that need further research and development. In Chapter 6 Riittta Haverinen and Nasrin Tabibian analyse integrated care, highlighting, with the user perspective at the heart of the project objectives, that users and informal carers are indispensable for improving care quality and service delivery. This is particularly so since the user's position has recently gone through a transition, evolving from a 'patient' to a 'service user', a 'consumer', even a 'commissioner' of services. The life-world of the user and the systems world of services and residences are not easily reconciled, but the chapter uses an innovative conceptual framework to identify mismatches and highlight areas for improvement. Charlotte Strumpel, Sirpa Andersson and Eftichia Teperoglou, in Chapter 7, discuss the most decisive factor for improvements in planning, communication, delivery and outcome measurement of integrated care, the professionals working in long-term care settings. They analysed staff perceptions in the various model ways of working, with a focus on the multifaceted work of those professionals who are dedicated to co-ordination and integration: the variety of tasks reaches from straightforward administrative activities to complex co-ordination and management responsibilities and, of course, hands-on health and social care provision.
Conclusion
The editors and Nasrin Tabibian summarise the most outstanding elements as factors for successful co-ordination and integration at the interface between health and social care delivery found during the research process. The list is far from exhaustive and, they say, should be used as a 'shopping list' for further research and experimentation in different cultural and organisational settings that are facing the challenges of an ageing society. Annexes give interview and documentation forms and model ways of working.
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