'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). 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.
'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). 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.
Extended abstract:
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.
240 references
Subject terms:
integrated services, interagency cooperation, models, multidisciplinary services, older people, social care, social care provision, health care;
Journal of Interprofessional Care, 19(3), June 2005, pp.317-325.
Publisher:
Taylor and Francis
Substantiated cases of elder self-neglect have been reported to be more common than either elder abuse or neglect. It is a problem that often requires the active involvement of a whole range of health, social, housing, police and voluntary agencies. The ways in which these various agencies respond to self-neglect and how they interact with one another is not known. This research explored the ways in which different health and social care organizations respond to the problems associated with self-neglect. Research methods involved qualitative in-depth interviews with housing, healthcare, environmental health and social workers and a sample of their clients who were described as living in self-neglecting circumstances. This study revealed a lack of joint working across the relevant professions in relation to self-neglect. Better co-ordinated intervention could improve effectiveness and help make available resources go further. The study also suggests a need for a preventative approach to self-neglect, although further work would be required to develop indicators for early intervention.
Substantiated cases of elder self-neglect have been reported to be more common than either elder abuse or neglect. It is a problem that often requires the active involvement of a whole range of health, social, housing, police and voluntary agencies. The ways in which these various agencies respond to self-neglect and how they interact with one another is not known. This research explored the ways in which different health and social care organizations respond to the problems associated with self-neglect. Research methods involved qualitative in-depth interviews with housing, healthcare, environmental health and social workers and a sample of their clients who were described as living in self-neglecting circumstances. This study revealed a lack of joint working across the relevant professions in relation to self-neglect. Better co-ordinated intervention could improve effectiveness and help make available resources go further. The study also suggests a need for a preventative approach to self-neglect, although further work would be required to develop indicators for early intervention.
Subject terms:
housing, interagency cooperation, intervention, older people, risk, self-neglect, social care, social care provision, social workers, health care;
Public Money and Management, 25(4), August 2005, pp.245-251.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Relationships between the NHS and social care services over the past 25 years have a poor history. This article examines the strategies that have been used by central government and by local NHS and social care organizations to overcome difficulties of service co-ordination in relation to services for older people and disabled adults. The article is written from the perspective of the NHS. The authors conclude that policies reflecting 'networked' modes of governance may stand the best chance of success, although evidence of improved impact and outcomes still remains scarce.
Relationships between the NHS and social care services over the past 25 years have a poor history. This article examines the strategies that have been used by central government and by local NHS and social care organizations to overcome difficulties of service co-ordination in relation to services for older people and disabled adults. The article is written from the perspective of the NHS. The authors conclude that policies reflecting 'networked' modes of governance may stand the best chance of success, although evidence of improved impact and outcomes still remains scarce.
Subject terms:
interagency cooperation, joint working, NHS, older people, physical disabilities, social services, social care, social care provision, central government;
Journal of Integrated Care, 12(1), February 2004, pp.3-8.
Publisher:
Emerald
Provides a European overview of alternative approaches to integrated care for older people, drawing from a wider European project entitled PROCARE. It discusses the structural complexities that create the challenges in integrated care, compares and contrasts approaches to integrated care through a structure and process framework, and considers the place of person-centred seamless care in European health and social care models.
Provides a European overview of alternative approaches to integrated care for older people, drawing from a wider European project entitled PROCARE. It discusses the structural complexities that create the challenges in integrated care, compares and contrasts approaches to integrated care through a structure and process framework, and considers the place of person-centred seamless care in European health and social care models.
Subject terms:
integrated services, interagency cooperation, models, multidisciplinary services, older people, social care, social care provision, health care;
Journal of Gerontological Social Work, 10(1), March 2000, pp.15-16.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Reports on a research project which aims to examine the literature published in the last 5 years, from countries with similar health and social care systems to that in the UK. The project aims to provide an evidence base of the strategies for, and effectiveness of, the transfer of patient/client information between hospital and community settings for elderly people with physical illness.
Reports on a research project which aims to examine the literature published in the last 5 years, from countries with similar health and social care systems to that in the UK. The project aims to provide an evidence base of the strategies for, and effectiveness of, the transfer of patient/client information between hospital and community settings for elderly people with physical illness.
Subject terms:
hospitals, interagency cooperation, joint working, interprofessional relations, older people, physical illness, social services, social care, social care provision;
Thematic review which looks at how well care for older people is integrated across health and social care, as well as the impact on older people who use services and their families and carers. The review collected evidence from eight areas site visits, reviewed care records, spoke to older people and their carers, and held focus groups with staff. It also looked at examples of where care was coordinated effectively and identified barriers that prevent it from working well. It discusses findings around three areas: identification and prevention, covering how well older people with complex needs or at high risk of deterioration are identified; person-centred assessment and planning; and care coordination. Key findings included that there was a widespread commitment to developing and delivering coordinated care. However, organisational barriers such as a lack of consistency in the use of assessments and in the sharing of information made it difficult for services to identify older people who were at risk of deterioration or an unplanned emergency admission. Older people often had multiple care plans and there was lack of knowledge among professionals of how care plans should be written and reviewed. The review also found insufficient monitoring and evaluation of many of the initiatives in place to improve integration. Where integrated, person-centred care succeeded, local leaders worked closely across health and social care services to share information, reduce duplicated efforts and use resources more effectively. Recommendations include: the development of a methodology and data set for identifying people at risk of admission to secondary care; and the development of a set of validated data metrics and outcomes measures for integrated care.
(Edited publisher abstract)
Thematic review which looks at how well care for older people is integrated across health and social care, as well as the impact on older people who use services and their families and carers. The review collected evidence from eight areas site visits, reviewed care records, spoke to older people and their carers, and held focus groups with staff. It also looked at examples of where care was coordinated effectively and identified barriers that prevent it from working well. It discusses findings around three areas: identification and prevention, covering how well older people with complex needs or at high risk of deterioration are identified; person-centred assessment and planning; and care coordination. Key findings included that there was a widespread commitment to developing and delivering coordinated care. However, organisational barriers such as a lack of consistency in the use of assessments and in the sharing of information made it difficult for services to identify older people who were at risk of deterioration or an unplanned emergency admission. Older people often had multiple care plans and there was lack of knowledge among professionals of how care plans should be written and reviewed. The review also found insufficient monitoring and evaluation of many of the initiatives in place to improve integration. Where integrated, person-centred care succeeded, local leaders worked closely across health and social care services to share information, reduce duplicated efforts and use resources more effectively. Recommendations include: the development of a methodology and data set for identifying people at risk of admission to secondary care; and the development of a set of validated data metrics and outcomes measures for integrated care.
(Edited publisher abstract)
Subject terms:
integrated care, older people, health care, social care, carers, care planning, person-centred planning, assessment, joint working, interagency cooperation, good practice;
Outlines the achievements of the Southwark and Lambeth Integrated Care (SLIC) programme, which was set up in 2012 as a partnership of commissioners and providers across health and social care, along with local people, to improve the value of care in Southwark and Lambeth. Its main aims were to identify and address care needs at an early stage; join up care around people and across providers; and provide care in the most appropriate setting. The programme began by focusing on the needs of people over 65, supporting them to remain independent in their own homes, and broadened to develop a ‘resilience’ based approach which supported people to take control of their own care. This report outlines the achievements of SLIC, highlights its key successes and challenges, and shares lessons learned. It explains how care was integrated care in Southwark and Lambeth and includes a ‘Framework for Success’ as a resource for others undertaking similar programmes of transformation. The Framework sets out the 12 elements that need to be addressed in taking forward any programme of integrating care, including the importance of agreeing the balance between cost saving and improving outcomes and patient experience; the necessity of robust measurement and evaluation; the need to co-create and clearly communication a vision; and the role of effective governance. The report concludes that the SLIC has had a positive impact on improving care for local people, and has built a strong foundation for further integrating health and social systems across the two boroughs.
(Edited publisher abstract)
Outlines the achievements of the Southwark and Lambeth Integrated Care (SLIC) programme, which was set up in 2012 as a partnership of commissioners and providers across health and social care, along with local people, to improve the value of care in Southwark and Lambeth. Its main aims were to identify and address care needs at an early stage; join up care around people and across providers; and provide care in the most appropriate setting. The programme began by focusing on the needs of people over 65, supporting them to remain independent in their own homes, and broadened to develop a ‘resilience’ based approach which supported people to take control of their own care. This report outlines the achievements of SLIC, highlights its key successes and challenges, and shares lessons learned. It explains how care was integrated care in Southwark and Lambeth and includes a ‘Framework for Success’ as a resource for others undertaking similar programmes of transformation. The Framework sets out the 12 elements that need to be addressed in taking forward any programme of integrating care, including the importance of agreeing the balance between cost saving and improving outcomes and patient experience; the necessity of robust measurement and evaluation; the need to co-create and clearly communication a vision; and the role of effective governance. The report concludes that the SLIC has had a positive impact on improving care for local people, and has built a strong foundation for further integrating health and social systems across the two boroughs.
(Edited publisher abstract)
Subject terms:
older people, integrated care, local authorities, health care, social care, commissioning, prevention, holistic care, early intervention, interagency cooperation, evaluation, NHS;
Reports on a literature review commissioned by the Commission on Improving Urgent Care for Older People to identify factors that deliver better outcomes and success in the improvement of urgent care for older people. Specifically the review aimed to identify current national policy for improving urgent care in both health and social care; relevant national guidance; and examples of research, best practice and innovation. The findings are presented around the themes of: demographics and the population of older people; what is meant by urgent care; the needs of older people, including needs related to multiple long term conditions; the capacity of urgent care, workforce; what works in the current NHS and Adult Social Care system. The review found limited evidence relating specifically to older people in relation to urgent care. It also identified a lack of consensus on what the term ‘urgent care’ means. Factors identified as influencing the effectiveness of urgent care delivery for older people included workforce/skill mix, competence in working with older people and awareness of their particular needs, integration, appropriateness of admission, pre-admission support, effective and safe discharge, the role of social care and capacity. The report also noted that the value of the role of community-based services, including social care, the voluntary sector, ambulatory services and of nursing and residential care homes is sometimes overlooked.
Reports on a literature review commissioned by the Commission on Improving Urgent Care for Older People to identify factors that deliver better outcomes and success in the improvement of urgent care for older people. Specifically the review aimed to identify current national policy for improving urgent care in both health and social care; relevant national guidance; and examples of research, best practice and innovation. The findings are presented around the themes of: demographics and the population of older people; what is meant by urgent care; the needs of older people, including needs related to multiple long term conditions; the capacity of urgent care, workforce; what works in the current NHS and Adult Social Care system. The review found limited evidence relating specifically to older people in relation to urgent care. It also identified a lack of consensus on what the term ‘urgent care’ means. Factors identified as influencing the effectiveness of urgent care delivery for older people included workforce/skill mix, competence in working with older people and awareness of their particular needs, integration, appropriateness of admission, pre-admission support, effective and safe discharge, the role of social care and capacity. The report also noted that the value of the role of community-based services, including social care, the voluntary sector, ambulatory services and of nursing and residential care homes is sometimes overlooked.
Subject terms:
older people, emergency health services, literature reviews, multidisciplinary teams, long term conditions, complex needs, good practice, hospital admission, interagency cooperation, prevention, social care;
COMMISSION ON IMPROVING URGENT CARE FOR OLDER PEOPLE
Publisher:
NHS Confederation
Publication year:
2016
Pagination:
44
Place of publication:
London
Final report from the Commission on Improving Urgent Care for Older People which provides guidance for those involved in designing care for older people and outlines eight key principles the health and care sector can adopt to improve urgent care for older people. The Commission was established out of a concern that the care system was not meeting the needs of older people, resulting in lower quality of care, a lack of out-of-hospital services as an alternative to A&E, not enough focus on prevention and early intervention, and delayed transfers of care. It brought together a range of experts, received over 60 evidence submissions; carried out visits to sites using innovative ways to deliver care; consulted with NHS Confederation members and patient and carer groups; and commissioned an evidence review. The report draws on the evidence to look at the case for change. It then outlines eight key principles that can be used when redesigning health and social care system: start with care driven by the person’s needs and personal goals; a greater focus on proactive care; acknowledge current strains on the system and allow time to think; the importance of care co-ordination and navigation; greater use of multi-disciplinary and multi-agency teams; ensure workforce, training and core skills reflect modern day requirements; leadership should encourage us to do things differently; and metrics must truly reflect the care experience for older people. Short case studies of innovative practice are included in the report, covering acute and primary care, voluntary sector and local government partners and commissioners.
(Edited publisher abstract)
Final report from the Commission on Improving Urgent Care for Older People which provides guidance for those involved in designing care for older people and outlines eight key principles the health and care sector can adopt to improve urgent care for older people. The Commission was established out of a concern that the care system was not meeting the needs of older people, resulting in lower quality of care, a lack of out-of-hospital services as an alternative to A&E, not enough focus on prevention and early intervention, and delayed transfers of care. It brought together a range of experts, received over 60 evidence submissions; carried out visits to sites using innovative ways to deliver care; consulted with NHS Confederation members and patient and carer groups; and commissioned an evidence review. The report draws on the evidence to look at the case for change. It then outlines eight key principles that can be used when redesigning health and social care system: start with care driven by the person’s needs and personal goals; a greater focus on proactive care; acknowledge current strains on the system and allow time to think; the importance of care co-ordination and navigation; greater use of multi-disciplinary and multi-agency teams; ensure workforce, training and core skills reflect modern day requirements; leadership should encourage us to do things differently; and metrics must truly reflect the care experience for older people. Short case studies of innovative practice are included in the report, covering acute and primary care, voluntary sector and local government partners and commissioners.
(Edited publisher abstract)
Subject terms:
delayed discharge, older people, emergency health services, hospital admission, long term conditions, complex needs, health care, social care, person-centred care, prevention, multidisciplinary teams, interagency cooperation, leadership, staff development;
Journal of Integrated Care, 13(2), April 2005, pp.13-21.
Publisher:
Emerald
Presents a comparison of the views of staff working in 18 integrated care settings, undertaken as part of the PROCARE study of integrated health and social care. The data reveals commonalities across the nine European countries (Austria, France, Germany, Italy, Finland, UK, Denmark, Greece and the Netherlands). Increased job satisfaction was an advantage of integrated working, but respondents also reported difficulties in working with hospitals or medical professionals, and continued barriers to integrated working generally. Single standalone organisations such as home care teams reported the clearest benefits from integrated working, while cross-agency models continued to encounter significant barriers to health and social care integration.
Presents a comparison of the views of staff working in 18 integrated care settings, undertaken as part of the PROCARE study of integrated health and social care. The data reveals commonalities across the nine European countries (Austria, France, Germany, Italy, Finland, UK, Denmark, Greece and the Netherlands). Increased job satisfaction was an advantage of integrated working, but respondents also reported difficulties in working with hospitals or medical professionals, and continued barriers to integrated working generally. Single standalone organisations such as home care teams reported the clearest benefits from integrated working, while cross-agency models continued to encounter significant barriers to health and social care integration.
Subject terms:
home care, integrated services, interagency cooperation, interprofessional relations, job satisfaction, older people, social care, social care provision, staff, attitudes, health;
Content type:
research
Location(s):
Austria, Denmark, Greece, Europe, Finland, France, Italy, Germany, Netherlands, United Kingdom