• Industry: Healthcare
  • Type: Survey report
  • Date: 5/21/2013

Integrate care 

Integrate care
Many long term care recipients have complex and multiple chronic conditions, yet the various services they receive tend to be poorly coordinated and fragmented, with visits from numerous professionals and conflicting advice. Providers are often paid for the hours of nursing care they deliver, rather than on outcomes, with a strong bias towards acute treatment.

As with other areas of health and social care, there is a growing interest in integrating care by bringing together family doctors, geriatricians, community nurses, occupational therapists, physiotherapists, speech therapists, dieticians, pharmacists, social workers and mental health workers. Over time this approach should mature to offer seamless services, with common IT systems that allow data sharing, common care pathways and accountable managers with single budgets coordinating multidisciplinary teams, leading to greater efficiency and better outcomes.

“Integration is essential and this is currently a real problem. Plans are not coordinated, health and social care are not integrated and housing is not incorporated. There is a need for integrated budgets and services.”

Baroness Sally Greengross, Commissioner, Equality and Human Rights Commission, UK

Caring for the elderly in hospitals is a huge – and in many cases, unnecessary – cost. As health systems are increasingly held to account for value and health outcomes (rather than volume), an integrated model can improve the quality and range of treatment within residential and nursing homes, which should reduce lengths of hospital stay and admissions.1

Elderly institutions require high-quality support from geriatricians, specialist nurses and other highly trained clinicians, while the care home staff will also need training to improve their skills in areas such as intravenous fluids, syringe pumps and pain management. Technology can play a big role, to enable specialists to remotely offer advice and review medications.

However, integration also carries some risks, not least by making patients overly dependent upon a single care provider. Such concerns can be mitigated to some extent by requiring integrated providers to offer choice and through carefully monitoring patient satisfaction and other performance measurements.

“The case manager should be the one that has the most logical position to execute the role. That could be the home care nurse, family or a social care worker. It is crucial that we do not institutionalize case management. That will only lead to higher costs.”

Gabrielle Davits, Chief Executive Officer, Foundation for Regional Healthcare (SVRZ), the Netherlands

1Choices, Policy Logics and Problems in the Design of Long-term Care Systems, Social Policy & Administration, December 2002.


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