Actionable policies for adopting high-quality integrated long-term care

Project Information

LAUREL

Grant agreement ID: 101132643

DOI

10.3030/101132643

EC signature date 7 November 2023

Start date 1 February 2024

End date 30 April 2027

Funded under

• Culture, creativity and inclusive society

Total cost

€ 2 774 812,51

EU contribution

€ 2 774 812,50

Coordinated by

FUNDACIO DE RECERCA CLINIC BARCELONA-INSTITUT D INVESTIGACIONS BIOMEDIQUES AUGUST PI I SUNYER
Spain

Periodic Reporting for period 1 - LAUREL (Actionable policies for adopting high-quality integrated long-term care)

Reporting period: 2024-02-01 to 2025-04-30

Summary of the context and overall objectives of the project

Long-term care (LTC) services support individuals who need help with daily activities—whether self-care (e.g. eating, bathing) or instrumental tasks (e.g. preparing meals, managing finances). Many also require permanent nursing care. These needs often arise from long-term physical or mental disabilities. While disability can affect people at any age, it becomes more common with ageing. Longer life expectancies also mean that younger individuals with severe disabilities, such as Down’s syndrome, may require LTC for extended periods. A life-course perspective is therefore increasingly important.
The rising demand for LTC services stems directly from an ageing population. Meeting this demand is already challenging, as seen during the COVID-19 pandemic, and will likely worsen with future crises. Nevertheless, people with disabilities deserve particular attention, as recognised by the United Nations. This has driven the European Union (EU) and its 27 member states (EU27) to commit to ensuring affordable, high-quality LTC, with emphasis on home and community-based care.
The LAUREL project aims to provide insights into regional differences in integrated long-term care (I-LTC) across Europe. Based on this, the project will develop practical policies to address key challenges, including rising demand, economic pressures, accessibility, affordability, service quality, workforce shortages, and system reform.
LAUREL will identify the most effective and innovative LTC solutions that support high-quality, person-centred care while reducing territorial and gender inequalities. The project has six key objectives:
1. Develop methods and tools to map and assess I-LTC services across the EU27, focusing on availability, accessibility, affordability, reliability, quality, workforce, funding, governance, autonomy, empowerment, and supporting technologies—integrating gender and regional (e.g. rural/urban) perspectives.
2. Conduct a field study across the EU27 to identify successful innovative practices.
3. Analyse the features of these I-LTC services and the conditions that support their adoption, including enabling technologies.
4. Carry out qualitative research to build consensus on actionable policies for transitioning to I-LTC, with attention to effective change management.
5. Produce a white paper summarising findings and policy recommendations.
6. Develop training and tools to maximise the uptake and impact of the project’s results.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

Rapid Realist Review of the Literature
A rapid realist review of post-2010 English-language literature identified 68 LTC-related frameworks, assessed against key policy dimensions such as governance, territorial equity, gender, stakeholder involvement, funding, social economy, life-course perspective, and digital technologies. Only seven frameworks covered four or more dimensions, with governance and stakeholder engagement being most common, and gender and digital technologies least addressed.

Strategy for Investigation and Analysis
The review informed a standardised strategy for data collection and analysis to support evidence-based I-LTC policymaking. Frameworks were reevaluated to exclude those under development, disease-specific, or too narrow for cross-national use were excluded. Fifteen robust frameworks were selected and analysed for recurring domains, leading to the creation of the European Framework for Long-term Integrated Care Services (FLINT).
FLINT consists of six domains: People and communities, Workforce and service delivery, Organisation of care, ICT and systems, Finance, and Governance, covering 35 items. Validated through expert surveys and focus groups, FLINT now guides an EU-wide field study mapping I-LTC initiatives across the 27 Member States.
The next step involves gathering insights from professional care providers and informal carers via targeted surveys and focus groups to identify enablers and barriers to I-LTC delivery. This research is ongoing.
Data will be deposited in CORA.RDR an open-access repository managed by the Catalan Open Research Area, in line with FAIR principles—Findable, Accessible, Interoperable, and Reusable. Submission and management protocols are established.

State-of-the-Art of Technologies Supporting I-LTC
The project assessed existing and emerging technologies relevant to I-LTC through reviews of the WHO LTC Framework, SELFIE Framework, Digital Care Horizon, and the ECDC Digital Technologies Review. Co-design workshops using persona-based scenarios identified stakeholder needs and mapped them to relevant technologies, highlighting adoption challenges, regulatory factors, and scaling considerations.
Assessment tools—including Technical, Service, and Business Readiness Levels (TRLs, SRLs, BRLs), Social Business Model Canvas, and Ethics Canvas—were used to evaluate technological maturity, sustainability, and ethical aspects.
The main output was a multi-dimensional quick assessment matrix to help policymakers map technologies to LTC functions, assess readiness, societal value, and ethical considerations, and guide adoption and scale-up.
Building on this, the Laurel Consortium developed the Digital Maturity Assessment Toolkit (DMAT) to assess digital readiness in I-LTC settings. Grounded in cutting-edge research, it evaluates technical, service, business, societal, and ethical dimensions. A structured process connects outcomes to tailored recommendations. Following a successful pilot, DMAT will be rolled out across further European I-LTC contexts.

Stakeholder Analysis Supporting I-LTC
To support policy recommendations and training tools, the project conducted a stakeholder analysis to prioritise engagement and communication.
Best practices such as the influence-interest matrix and value proposition canvas were applied in participatory sessions with project partners and stakeholders. Fourteen stakeholder types were identified and grouped into three priority clusters based on influence and interest in LTC policy.
A focus group applied the value proposition canvas to explore roles, challenges (pains), benefits (gains), and solutions for eleven stakeholder types. This resulted in tailored key messages for each group, to be delivered through appropriate communication channels.
The analysis outcomes will also support three additional activities within the Laurel project.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

As the project is still in its development phase, results beyond the current state of the art remain limited.
However, the need to map and characterise I-LTC services across the EU27 has led to the creation of the FLINT framework, representing a significant advancement in the field.
Similarly, the multi-dimensional quick assessment matrix allows policymakers to systematically evaluate emerging digital innovations in LTC, considering technological readiness, societal value, and ethical aspects—marking a relevant addition to the technological landscape.
The same applies to the Digital Maturity Assessment Toolkit (DMAT), which provides I-LTC initiatives with a structured approach to assess and improve their digital capabilities. By combining diagnostic insights with targeted guidance, the DMAT supports organisational development and digital transformation across the sector.