Integrated care for older people: Is it happening in practice

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Integrated care for older people Is it
happening in practice?

• Dr. Henk Nies
• Vilans, Netherlands Centre of Expertise for
  Long-Term Care
• Utrecht, The Netherlands

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Presentation

• Paradigm shifts in LTC
• Current situation
• Integration
• Effective mechanisms of integration
• Organisation
• Concluding remarks

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WHO definition LTC (2000)

• the system of activities undertaken by informal
  caregivers (family, friends and/or neighbours)
  and/or professionals (health and social services)
  to ensure that a person who is not fully capable
  of self-care can maintain the highest possible
  quality of life, according to his or her
  individual preferences, with the greatest
  possible degree of independence, autonomy,
  participation, personal fulfilment and human
  dignity

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Key concepts

• self-direction/controlquality of life
• social participation
• autonomy
• personal fulfilment
• human dignity

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Responsibility of

• Older person self care
• Social network informal care
• Care workers professional care

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Paradigm shifts

• Patient ? Consumer/client
• Professional dominance ? Shared decision making
• Quality of care ? Quality of life/ dignity
• Highest levels of dependency ? Rehabilitation and
  prevention

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Current situation

• understaffing (quality, numbers)
• under-funding
• fragmentation
• inequalities in access
• counteracting systems
• unbalances
• diffuse responsibility

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Reforms

• Continuity of care
• Connecting administrative levels
• Market mechanisms
• Transparency quality visible (indicators)
• Funding of outcomes (less inputs)
• Personal budgets/cash allowances

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Integration

• Self-care, informal care and professional care
• LTC, acute care, public health, rehabilitation,
  mental health
• Sectors
• Care
• Housing
• Technology
• Neighbourhood development
• Social care and welfare
• Social protection.

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Empowerment
Housing
Multi- disciplinary Team
Single point of entry
Needs assessment/ Service plan
Respite care
Case management
Joint budget
Information system
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Client characteristics and full integration

• Complex, multiple messy problems
• Severe levels of dependency
• Unstable, unpredictable conditions
• A need for a range of services
• A need for high intensity of service provision
• Long-term or terminal needs
• A weak sense of self-direction
• A weak social structure

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National Dementia Programme (NL)

• 610 participants, 97 focus groups
• gt1500 informal carers Dementia
  Care-questionnaire
• 2,587 calls at Alzheimer Telephone

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Top 5

• What is going on and what would help?
• I dont trust it!
• It is getting me too much!
• Miscommunication with care worker/professional,
  or the professional as the main problem!
• It makes me fearful, angry and confused!

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Solutions

• Improved relation GP - nursing staff
• Websites memory support centre
• Fully operational geriatric team in the community
• Day care in the community

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Concluding remarks

• Is it happening in practice? Yes, it is!
• Are we there? No, we arent!
• Challenges? Yes, many!
• Quality of life indicators
• Empowerment
• ICT
• Funding
• Evidence
• All relevant sectors
• Many et ceteras

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Thank you!

• h.nies_at_vilans.nl