Implementing a continuum of care model for older people-results from a Swedish case study (original) (raw)
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Organizing integrated care for older persons: strategies in Sweden during the past decade
Journal of health organization and management, 2015
Purpose - The purpose of this paper is to describe and analyse ways of organizing integrated care for older persons in Sweden during the past decade. Design/methodology/approach - The data consist of 62 cases of development work, described in official reports. A meta-analysis of cases was performed, including content analysis of each case. A theoretical framework comprising different forms of integration (co-ordination, contracting, co-operation and collaboration) was applied. Findings - Co-operation was common and collaboration, including multiprofessional teamwork, was rare in the cases. Contracting can be questioned as being a form of integration, and the introduction of consumer choice models appeared problematic in inter-organization integration. Goals stated in the cases concerned steering and designing care, rather than outcome specifications for older persons. Explicit goals to improve integration in itself could imply that the organizations adapt to strong normative expecta...
Organizing integrated care for older persons : strategies in Sweden
2014
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Health Policy, 2015
Although multi-disciplinary cooperation between professionals is a prerequisite to provide integrated care in the community, this seems hard to realise in practice. Yet, little is known about the experiences of professionals who implement it nor about the organisational features professionals identify as empowering during this cooperation process. Therefore, a case study of a multi-disciplinary geriatric team was performed. The data-collection included observations of meetings, in-depth interviews and focus groups with professionals (N = 12). Data were analysed inductively and related to the three organisational levels within the model of organisational empowerment of Peterson and Zimmerman. Signs of empowering organisational features on the intraorganisational level were mutual trust and clear working routines. On the interorganisational level important features included improved linkages between participating organisations and increased insight into each other's tasks. Tensions occurred relating to the inter- and the extraorganisational level. Professionals felt that the commitment of the management of involved organisations should be improved just as the capacity of the team to influence (local) policy. It is recommended that policymakers should not determine the nature of professional cooperation in advance, but to leave that to the local context as well as to the judgement of involved professionals.
Journal of Health Organization and Management
PurposeThe purpose of this paper was to develop deeper insights into the practices enacted by entrepreneurial healthcare managers to enhance the implementation of a partnership logic in integrated care models for older adults.Design/methodology/approachA multiple case study design in two urban centres in two jurisdictions in Canada, Ontario and Quebec. Data collection included 65 semi-structured interviews with policymakers, managers and providers and analysis of key policy documents. The institutional entrepreneur theory provided the theoretical lens and informed a reflexive iterative data analysis.FindingsWhile each case faced unique challenges, there were similarities and differences in how managers enhanced a partnership’s institutional logic. In both cases, entrepreneurial healthcare managers created new roles, negotiated mutually beneficial agreements and co-located staff to foster inter-organisational partnerships between public, private and community organisations in the con...
Social Policy & …, 2003
A common problem in the provision of coordinated long-term care is the separation of health and social care. The present government has been increasingly concerned with promoting convenient, user-centred services and improving integration of health and social care. One arrangement that could contribute to this for some older service users is for health care staff to act as care managers, coordinating the provision of both health and social care. This paper presents the findings of a survey of arrangements in place in local authorities for health staff to work as care managers for older people. This was designed to provide details about the range and scope of care management activities undertaken by health care professionals. Key areas of enquiry included: which kinds of health care staff undertook care management and in what settings; how long the arrangements had been in place and how widely available they were; whether there was a distinction between the types of cases and care management processes undertaken by health care staff compared with their social service department counterparts; and what management and training arrangements were in place for the health care staff.
Developing integrated health and social care services for older persons in Europe
International Journal of Integrated Care, 2004
This paper is to distribute first results of the EU Fifth Framework Project 'Providing integrated health and social care for older persons-issues, problems and solutions'; (PROCARE-http://www.euro.centre.org/procare/). The project's first phase was to identify different approaches to integration as well as structural, organisational, economic and social-cultural factors and actors that constitute integrated and sustainable care systems. It also served to retrieve a number of experiences, model ways of working and demonstration projects in the participating countries which are currently being analysed in order to learn from success-or failure-and to develop policy recommendations for the local, national and European level. The paper draws on existing definitions of integrated care in various countries and by various scholars. Given the context of an international comparative study it tries to avoid providing a single, ready-made definition but underlines the role of social...
Partnership Working in the Long-term Care System for Older People
Asian Journal of Human Services
This paper based on qualitative cross-national research at national, municipal and local level in England, the Netherlands and Taiwan explores whether relevant actors were sharing the same goals, whether they communicated well with each other and whether they were working together with the service users. Through horizontal and vertical partnership analysis, the study found the care actors from top to bottom were not always sharing the same goals and priorities about how long-term care should be delivered. The split between health and social care in the care system has constituted a great challenge in working in partnership in English and Taiwanese practice. Whereas having a strong culture and ideology of solidarity and consultation embedded in the care system has helped the Dutch care actors to have a more equal working partnership. Most importantly, the involvement of all the care actors in policy and practice planning and decision-making is crucial if a better joint-working structure to fulfil the policy intention of providing a seamless long-term care service in practice is to be achieved. ＜Key-words＞ partnership, long-term care, older people, England, the Netherlands, Taiwan
Care management for older people: Does integration make a difference?
Journal of Interprofessional Care, 2006
England and Northern Ireland provide examples of different degrees of integration of health and social care within broadly similar administrative and funding frameworks. This paper examines whether integrated structures appear to impact upon the operation of care management, a key approach to providing coordinated care for vulnerable older people. There appeared to be more evidence of integrated practice between health and social care in Northern Ireland than England, although some key features, such as intensive care management, were no more evident. It is concluded that further investigation is required as to the extent to which integrated structures have impacted upon patterns of professional working and underlying beliefs about roles.
A 10 Step Framework to Implement Integrated Care for Older Persons
Ageing International, 2019
An aging population, whose multi-morbidities and risk of frailty increase with age results in significant health and social care consumption. Increasing complexity amplifies fragmentation of care and results in sub optimal care outcomes. Ireland, in keeping with other jurisdictions seeks to implement integrated care for older persons as a policy response. There is growing evidence base supporting effective service responses for older persons. These typically include multidisciplinary, community based teams providing services in or near to the older person's home (the 'what'). However, examples of systemic implementation are confined to smaller regions notably in Catalonia (Spain), Scotland and Singapore. This reflects the fact that the implementation of integrated care is problematic at scale. The need to attend to methods that support high autonomy professionals tasked with local implementation (the 'who') is a neglected area. This is especially important in light of the fact managerial and clinical leaders already have operational and clinical imperatives to attend to. Whilst ideologically committed, the change management challenge presented by integrated care is daunting as they may lack the capacity (time, resources, structures) required to test a new care model. In addition, the change methodology fails to recognise powerful social dynamics that reflect the characteristics of a complex adaptive system (the 'how'). This paper proposes a framework to implementing integrated care for older persons. In addition, it offers some initial empirical evidence that this approach has utility among managers and clinicians. In doing so seeks to bridge the implementation gap associated with systemic change.
Accounts of professional and institutional tension in the context of Swedish elderly care
Journal of Aging Studies, 2010
This article describes need assessment dialogues, the circumstances surrounding care, and the provision of residential care and in-home support for the elderly in Sweden, as seen from a communicative perspective. The purpose was to systematically describe and analyse the accounts of welfare officers concerning elderly care. The research questions were: How is the internal care context perceived and constituted through discourse? How do welfare officers manage the daily demands, expectations, tasks, and dilemmas in the encounter with the individual citizen? What significance do the welfare officers give their work and their professional tasks? Eleven interviews with welfare officers from elderly and handicapped care organisation of three municipalities were held, and a discursive analysis was made from the collected data. Four characteristic discursive phenomena in the welfare officers' accounts were observed: (I) the rights of the elderly, (II) living at home, (III) good relations, and (IV) the complaisance. The study shows that the dialogues with elderly contain communicative dilemmas and mixed loyalties. The welfare officers navigate between different perspectives and double approaches. She/he uses the navigating as a strategy and proficiency in their work. However, these proficiencies remain largely unnoticed and unreflected as techniques, strategies, or tools for attaining favourable care.