1 Integrated Care for Older People: Management and Policy Issues Henk Nies, PhD NIZW, The Netherlands

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Presentation transcript:

1 Integrated Care for Older People: Management and Policy Issues Henk Nies, PhD NIZW, The Netherlands

2 Presentation l The CARMEN network l Case/vignette l The concept of integrated care l Who cares? l Who pays? l Who decides? l Issues to be addressed

3 CARMEN: the actors l Users l Carers l Primary care l Acute hospitals l Care homes l Social care l Purchasers l Researchers l Consultants l Other

4 CARMEN: the countries l Belgium l Finland l Germany l Greece l Ireland l Italy l The Netherlands l Spain l Sweden l UK

5 Mrs Costa l 78 years l widow l dementia l migrated l cleaning women l 3 children l 1 child abroad l poor contacts l minimum old age pension l discharge after mild stroke l difficulties in moving in the house l disagreement children

6 l Traditional (e.g. questionnaires, reviews) l Descriptive (e.g. structured analyses, cases) l Qualitative (e.g. vignettes) l Internal inputs (subgroups, plenary sessions) l External inputs (e.g. experts’ presentations Methods

7 ‘A well planned and well organised set of services and care processes, targeted at the multiple needs/ problems of an individual client, or a category of persons with similar needs/problems’ Integrated care (Vaarama, 2001)

8 Integration (Leutz, 1999) l Linkage l Co-ordination l Full integration

9 Who cares? l Professionals ánd informal carers l Threats: 3demography 3low status 3geographic mobility

10 Who cares? l Complications 3qualifications incomparable and incompatible 3who cares in the homeland? 3immigrant and refugees as a resource

11 Who cares? l Prospects 3more effective use of staff 3less duplication 3flexible employment 3job enrichment 3new roles 3less demand

12 Who pays? l Diversity in long term care: 3services 3agencies 3local community 3old people themselves 3legislative frameworks 3policy levels 3professional cultures Ù fragmentation

13 Who pays? l Complications 3imbalances in the system 3coverage 3inter-dependency of health care and social care, housing, transport etc 3cash benefits: more providers 3‘buyers power’ 3entitlement of citizens abroad

14 Who pays? l Solutions? 3 debate on Services of General Interest 3 strengthening the voice of older people

15 Who decides? l Supply driven systems l Final responsibility fragmented: good will l Mergers: no choice, no competition, better integration? l Assumptions underlying benefits in cash, underlying the market mechnisms l Buyers power l Older people themselves

16 Issues to be addressed l Qualifications of staff, new professionals l Balance of new mobility l Accessibility, quality and financial sustainability in the internal market l Care for older people outside country of origine l Empowerment of older people