Managing effective partnerships in older people's services

Abstract

The integration of older people's services is a challenge to all countries with an ageing population. Although it is widely acknowledged that acute care, long-term care, social care, housing, leisure, education and other services should all operate in a more 'joined-up manner', achieving this in practice remains extremely difficult. Against this background, the European Union (EU) Care and Management of Services for Older People in Europe Network (CARMEN) project set out to explore the management of integrated care in 11 EU countries. Summarising key themes from the project, this paper explores the management of integrated care, the skills required, the mechanisms which aid successful integrated approaches, and future research priorities. Although very challenging, the concept of integrated care is still a promising way forward when seeking to meet the challenges of an ageing society.

The policy, structure and evaluation of long-term care networks: the differentiated requirements referred to the example of integrated long-term care in Austria

“…• the association of independently operating units (Nies, 2006;Ollonqvist et al, 2007) • voluntary participation in the network (Kaur, 2006) • the pursuit of joint or overriding objectives (Kodner, 2006;Montreuil and Garon, 2005) • the consistency of the processes (Piven et al, 2006;Rantz et al, 2004;Whitehead et al, 2001) • coordinated information management and DSS (Kodner, 2006;Lapane et al, 2006;O'Neil et al, 2004) • comparable documentation (Cavanagh, 2002;Mackenzie et al, 1998;Schnelle and Ouslander, 1997) • compatible technology (Kaushal et al, 2005;Schnelle et al, 2005;Scritchfield, 2007) • defined minimum data (Piven et al, 2006) • coordinated services planning (Caris-Verhallen and Kerkstra, 2001;Jacobs and Rummery, 2002;Lyons et al, 1995;Nies, 2006) • joint quality criteria (Grabowski et al, 2004;Hilliard, 2005;Rantz et al, 2000;Simmons et al, 2004;Stevenson, 2006;Zimmerman, 2003).…”

“…At the functional level, however, it has to be concluded that standardisation has not been provided for to an extent that would constitute a criterion of efficiency -and therefore, also a functional criterion -of a long-term care network (Nies, 2006). Table 2 presents the aggregated interfering variables surveyed, those problem areas which influence the transfer process in view of the respective core process of the institutions involved.…”

“…The fact that within the Tyrol long-term care network, distributed decision-making and nursing institutions that operate without being bracketed institutionally together has become established as self-evident at every level surveyed and is no longer questioned. However, the level of independence is indeed questionable, especially where the financing and the issues of resource distribution are associated with the problem of building a reputation within certain hierarchically organised typologies (Dickerson et al, 2006;Nies, 2006;Polivka, 2003).…”

Organisational Integration in Health and Social Care: Some Reflections on the Northern Ireland Experience

“…As already noted, achieving a genuine partnership is challenging due to a range of structural, cultural and organisational differences. The persistence of organisational and professional protectionism has blighted attempts to achieve integrated working (Glendinning, 2003;Nies, 2006). Partnerships are prone to break down over disputes about funding, priorities, management, and the design and delivery of services.…”

Working towards integrated community care for older people: Empowering organisational features from a professional perspective

“…Moreover, research shows that the rise of integrated care teams did not necessarily result in a greater proportion of older people remaining living at home [19]. Barriers mentioned in the literature include cultural cleavages between professionals [12,20], interface problems between professionals and organisations [21], organisational and procedural rules and regulations prevailing in the sector [12,22], the supply-driven design of the system, the complexity of the system, financial and legislative problems [21], limited outside expertise and management capacity [23] and power relationships between newly integrated services and professionals [20].…”