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Health systems and long-term care for older people in Europe – Modelling the INTERfaces and LINKS between prevention, rehabilitation, quality of services and informal care

Periodic Report Summary - INTERLINKS (Health systems and long-term care for older people in Europe modelling the interfaces and links between prevention, rehabilitation, quality of services ...)

INTERLINKS is a three year project carried out by a consortium of 16 partners from 14 European countries. It elaborates on the interfaces and links between health and long-term care (LTC) focusing on prevention and rehabilitation (P&R), quality of care, informal carers as well as on governance and financing of LTC. Results of the individual work packages will converge in a general model for describing, analysing and improving emerging LTC systems in Europe. During the first 18 months of the project the following tasks were fulfilled:

- The development of a general approach and methodological guidelines as well as guidance for literature reviews helped to compile national reports and European overviews focusing on P&R, quality assurance and quality management (QA/QM) as well as on informal care in LTC.
- National Expert Panels (NEPs) were established by inviting experts, policy-makers, and representatives of provider and user organisations to identify model ways of working and relevant other information for national reports and to provide feedback on European overview papers.
- A Sounding Board was established on a European level by inviting 20 representatives from policy-making, practice and research to the First Sounding Board conference during which draft results were presented and discussed, feeding into the final versions of the European overviews. Key results during the first phase support the general hypothesis that LTC as a system is only just emerging in most European countries. Still, there are elements and practices that show how to improve fragmented structures and procedures at the health and social care divide, i.e. at the interfaces between health and social care. In particular, the following issues will guide further work on elements, themes and practice examples to describe and analyse LTC in Europe:
- Gaps experienced by patients and users are often filled by informal carers, but also the formal-informal care divide is becoming increasingly fragile and blurred. This is highlighted by the phenomenon of migrant carers having become one of the most important sources of care in Mediterranean and Central European countries. In order to sustain the currently expanding 'mixed care workforce' (informal family carers, migrant workers, professional care staff) more comprehensive LTC policies are necessary, including a mixture of cash-for-care benefits, social security, respite services and other forms of support.
- Concerning P&R, professional quality and care integration have substantial effects while gaps and overlaps in care pathways render poor health outcomes. However, P&R initiatives within LTC are often of a short-term nature and show only fragmentary evidence. Health promotion and prevention are considered as being most useful if targeted at people at working age, while older people are still given less focus. First signs for embedding P&R within LTC at a national, systemic level can be recognised, e.g. national awareness raising events and multidisciplinary preventive and rehabilitative services in community settings.
- In relation to QA/QM, there are tendencies towards increased transparency by means of self-regulation and the application of adapted QM systems by individual providers of LTC, partly incentivised by market mechanisms, partly imposed by governance mechanisms (accreditation or certification by third parties). This implies a development from pure inspection towards self-assessment and continuous improvement. There is a need to sustain these developments by enabling stakeholders not only on the level of individual organisations, but across the 'continuum of care' reaching from health (including P&R) to community care services and their links to informal carers.

INTERLINKS will continue to enable policy and decision makers to assess, manage and reform LTC systems and have tools to monitor its results in view of common challenges in the European Union.