https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)60342-6.pdf

Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis.

Quasi-markets and social policy

Summary Faced with the problems associated with an ageing society, many European countries have adopted innovative policies to achieve a better balance between the need to expand social care and the imperative to curb public spending. Although embedded within peculiar national traditions, these new policies share some characteristics: (a) a tendency to combine monetary transfers to families with the provision of in-kind services; (b) the establishment of a new social care market based on competition; (c) the empowerment of users through their increased purchasing power; and (d) the introduction of funding measures intended to foster care-giving through family networks. This article presents the most significant reforms recently introduced in six European countries (France, Germany, Italy, the Netherlands, Sweden and the UK) as regards long-term care. It analyses their impact at the macro- (institutional and quantitative), meso- (service delivery structures) and micro-level (families, caregivers and people in need). As a result the authors find a general trend towards convergence in social care among the countries, and the emergence of a new type of government regulation designed to restructure rather than to reduce welfare programmes.

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Restructuring the welfare state: reforms in long-term care in Western European countries

Background: Health and social services provided at home are becoming increasingly important. Hence, there is a need for information on home care in Europe. The objective of this literature review was to respond to this need by systematically describing what has been reported on home care in Europe in the scientific literature over the past decade. Methods: A systematic literature search was performed for papers on home care published in English, using the following data bases: Cinahl, the Cochrane Library, Embase, Medline, PsycINFO, Sociological Abstracts, Social Services Abstracts, and Social Care Online. Studies were only included if they complied with the definition of home care, were published between January 1998 and October 2009, and dealt with at least one of the 31 specified countries. Clinical interventions, instrument developments, local projects and reviews were excluded. The data extracted included: the characteristics of the study and aspects of home care ‘policy & regulation’, ‘financing’, ‘organisation & service delivery’, and ‘clients & informal carers’. Results: Seventy-four out of 5,133 potentially relevant studies met the inclusion criteria, providing information on 18 countries. Many focused on the characteristics of home care recipients and on the organisation of home care. Geographical inequalities, market forces, quality and integration of services were also among the issues frequently discussed. Conclusions: Home care systems appeared to differ both between and within countries. The papers included, however, provided only a limited picture of home care. Many studies only focused on one aspect of the home care system and international comparative studies were rare. Furthermore, little information emerged on home care financing and on home care in general in Eastern Europe. This review clearly shows the need for more scientific publications on home care, especially studies comparing countries. A comprehensive and more complete insight into the state of home care in Europe requires the gathering of information using a uniform framework and methodology.

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Home care in Europe: a systematic literature review

Integrated care is a key strategy in reforming health systems around the world. Despite its importance, the concept's polymorphous nature and lack of specificity and clarity significantly hamper systematic understanding, successful application and meaningful evaluation. This article explores the many definitions, concepts, logics and methods found in health system and service integration. In addition to framing this evolving, albeit imprecise field, the article summarizes the main elements or building blocks of integrated care and suggests a way to address its various complexities and unknowns in a real-world sense.

All Together Now: A Conceptual Exploration of Integrated Care.

Purpose: 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. Theory: 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 care as part and parcel of this type of integrated care in the participating countries. Methods: The paper is based on national reports from researchers representing ten organisations (university institutes, consultancy firms, research institutes, the public and the NGO sector) from 9 European countries: Austria, Denmark, Finland, France, Germany, Greece, Italy, the Netherlands, and the UK. Literature reviews made intensive use of grey literature and evaluation studies in the context of at least five model ways of working in each country. Results: As a result of the cross-national overview an attempt to classify different approaches and definitions is made and indicators of relative importance of the different instruments used in integrating health and social care services are provided. Conclusions: The cross-national overview shows that issues concerning co-ordination and integration of services are high on the agenda in most countries. Depending on the state of service development, various approaches and instruments can be observed. Different national frameworks, in particular with respect to financing and organisation, systemic development, professionalisation and professional cultures, basic societal values (family ethics), and political approaches have to be taken into account during the second phase of PROCARE during which transversal and transnational analysis will be undertaken based on an in-depth analysis of two model ways of working in each country. Discussion: Far from a European vision concerning integrated care, national health and social care systems remain—at best—loosely coupled systems that are facing increasing difficulties, given the current challenges, in particular in long-term care for older persons: increasing marketisation, lack of managerial knowledge (co-operation, co-ordination), shortage of care workers and a general trend towards down-sizing of social care services continue to hamper the first tentative pathways towards integrated care systems.

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Developing integrated health and social care services for older persons in Europe.

PART I: INTRODUCTION Addressing Long-Term Care as a System Jenny Billings, K.Leichsenring & L.Wagner The Emerging Identity of Long-Term Care Systems in Europe H.Nies, K.Leichsenring & S.Mak PART II: OVERCOMING THE HEALTH-SOCIAL CARE DIVIDE AND THE FORMAL-INFORMAL CARE DIVIDE User Perspectives: Examining LTC Policies from the Standpoint of Older People in Need of Care and Informal Carers M.Naiditch, J.Triantafillou, P.Di Santo, S.Carretero & E.Hirsch-Durrett Joint Working Between Health and Social Care K.Allen, J.Glasby & R.Rodrigues Converging Methods to Link Social and Health Care Systems and Informal Care: Confronting Nordic and Mediterranean Approaches J.Garces, F.Rodenas & T.Hammar Integration as 'Boundary Redefinition Process' P.Gobet & T.Emilsson PART III: INNOVATIVE CASES IN THE CONSTRUCTION OF LONG-TERM CARE IN EUROPE Prevention and Rehabilitation Within Long-Term Care: Applying a Comprehensive Perspective S.Kumpers, A.Dieterich, G.Ruppe & L.Wagner The Quest for Quality in LTC K.Leichsenring, H.Nies & R.van der Veen Making Sense of Differences: The Mixed Economy of Funding and Delivering Long-Term Care R.Rodrigues & H.Nies The 'Care Gap' and Migrant Carers R.Bednarik, P.Di Santo & K.Leichsenring Volunteering in Long-Term Care for Older People: The Potential for Social Innovation K.Repkova, K.Stiehr & B.Weigl The Role of Information Technology in LTC for Older People J.Billings, S.Carretero, G.Kagialaris, T.Mastroyiannakis & S.Merilainen-Porras Palliative Care Within Long-Term Care Systems: Beyond End of Life? L.Holdsworth & G.Ruppe PART IV: CONCLUSIONS Improving the Evidence Base J.Billings Improving Policy and Practice in Long-Term Care K.Leichsenring, J.Billings & H.Nies

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Long-Term Care in Europe: Improving Policy and Practice

Introduction: Integrated care programmes are increasingly being put in place to provide care to older people who live at home. Knowledge of how to further develop integrated care and how to transfer successful initiatives to other contexts is still limited. Therefore, a cross-European research project, called Sustainable Tailored Integrated Care for Older People in Europe (SUSTAIN), has been initiated with a twofold objective: 1. to collaborate with local stakeholders to support and monitor improvements to established integrated care initiatives for older people with multiple health and social care needs. Improvements focus on person-centredness, prevention orientation, safety and efficiency; 2. to make these improvements applicable and adaptable to other health and social care systems, and regions in Europe. This paper presents the overall structure and approach of the SUSTAIN project. Methods: SUSTAIN uses a multiple embedded case study design. In three phases, SUSTAIN partners: (i) conduct interviews and workshops with stakeholders from fourteen established integrated care initiatives to understand where they would prefer improvements to existing ways of working; (ii) collaborate with local stakeholders to support the design and implementation of improvement plans, evaluate implementation progress and outcomes per initiative, and carry out overarching analyses to compare the different initiatives, and; (iii) translate knowledge and experience to an online roadmap. Discussion: SUSTAIN aims to generate evidence on how to improve integrated care, and apply and transfer the knowledge gained to other health and social care systems, and regions. Lessons learned will be brought together in practical tools to inform and support policy-makers and decision-makers, as well as other stakeholders involved in integrated care, to manage and improve care for older people living at home.

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The SUSTAIN Project: A European Study on Improving Integrated Care for Older People Living at Home

“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 defi ning 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.
Following the publication of a fi rst book published in March 2004, the current volume
on “Integrating Health and Social Care Services for Older Persons. Evidence from
Nine European Countries” will draw on the achievements of the second project phase
(2003-2004) that consisted in empirical fi eldwork 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, the UK).
The book underpins the more general national and European considerations gathered
in the project with empirical fi ndings analysed in 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 unique general overview on European approaches towards integrated social
and health care services and policies that are to be developed to face the growing
need of 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 fi gures about coordination at the interface between health and social
care for older persons;
• as well as problems and solutions (“lessons to learn”) concerning regulation and
coordination.

Kai Leichsenring

Papers

Developing integrated health and social care services for older persons in Europe.

Long-Term Care in Europe: Improving Policy and Practice

The SUSTAIN Project: A European Study on Improving Integrated Care for Older People Living at Home

Integrating health and social care services for older persons : evidence from nine European countries

The public gets what the public wants: experiences of public reporting in long-term care in Europe.