The National Ageing Research Institute has prepared a report for the Royal Commission into Aged Care Quality and Safety. The report reveals that integrated models for care, health and housing that are embedded in the community are the most effective at empowering clients and carers to meet their own needs and preferences. The report incorporates literature reviews on integrated care models and consultation with experts and providers of integrated care in Australia, to provide an analysis of integrated models of care for older people, as they relate to health care, social care and housing or accommodation in Australia.
Researchers describe integrated care as the strategies aimed at overcoming fragmentation between different services and sectors, and a way of improving the health and wellbeing of clients, service sustainability and client satisfaction with services. Service fragmentation can occur due to service duplication, poor communication between service providers, a greater likelihood of error, unmet needs, client disempowerment and low satisfaction with care.
Integrated care has been a popular policy goal in Australia, but researchers indicate that changes in practice tend to trail behind these policy intentions, with most existing models in the community focused on health care, rather than inclusive of care and accommodation needs of older people. While some models wrap care around the individual, others integrate services that address the broader population needs of a specific community, such as regional services that coordinate health, community care and aged residential services.
The community can be a geographic group, but can also be individuals connected through their social, religious or cultural communities. The report addresses the need for support when older people first engage with services and struggle to navigate the system. The report recommended the employment of social workers for short-term support to stabilise the situation and be a point of contact.
Researchers noted that there is often an assumption that older people have secure accommodation and the means to modify their accommodation so it is accessible as they age. However, this is not accurate for all groups, with researchers concluding that co-housing is a model that could help this gap. Co-housing is a model of creating a community comprised of individual dwellings, with benefits of social connectedness and community life. Residents are involved in the design and management of their own communities, including private residences and communal spaces.
Conclusions and recommendations
The report reveals that care integration works best when it is a bottom-up and community-focused process, with formalised partnerships between organisations based on shared goals. The research also suggests that more attention could be given to supporting older people at the entry points to health, aged care and other services, and to promoting community-level initiatives, which engender trust and reciprocity between community members.
The research also recommends exploring barriers faced by aged-care providers in forming alliances with other organisations to provide integrated care and looking into flexible options for integrating home care into housing options that still afford clients choice. The report suggests an integrated life-course approach, to integrate older people with their communities, rather than siloed aged care.
The researchers consider that, as a minimum, Commonwealth and state governments should consider incorporating measurable performance indicators into their service contracts so that grass-roots organisations can demonstrate how they are trying to incorporate integrated care thinking into their service models and measure the impact of these changes.
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