30 Integrated community-based care for home-dwelling older people

The study comprised the three phases development, implementation and evaluation. The first two phases were completed. In the first phase, an integrated care model consisting of a frailty risk assessment, assessment of care and nursing needs, individual care plan and follow-up on the situation of elderly people living at home was developed. The model was implemented and evaluated for its feasibility in the second phase, although the assessment of its effectiveness has still to be completed in 2024. As a contribution to cantonal care planning, an estimate of cause-specific mortality for people living at home in the different care regions was also prepared for the period up to 2030.

Most elderly people want to continue living in their own homes for as long as possible. If they become frail, they need comprehensive care and nursing from a range of professionals. However, the services provided are often neither centralised nor coordinated, which can negatively influence the quality and cost of the care provided to the elderly. Integrated care models are recommended as a way of counteracting this fragmentation.

The aim of the study was to develop, implement and evaluate an integrated, community-based model of care in the Information and Advice Centers (IAC) of two care regions in the Canton of Basel-Landschaft in the context of the Canton’s new care law. This piece of legislation was intended to promote the individual-centred care of elderly people living at home through the establishment of an IAC as a way of improving the quality and efficiency of care.

The results of the second phase showed that the integrated care model had low reach (below 5%) of elderly people with functional and health dependencies living at home despite its high acceptability and feasibility among older adults themselves, their caregivers, and the IAC staff. In addition, the study indicated a low level of engagement of local professionals in the referral of elderly people to the center, explained by the poor promotion of the center. Given these results, the model and associated implementation strategies will be adapted to reach more elderly people going forward and thus achieve greater efficiency.

The study identified the challenges associated with and resources required for the implementation of integrated care models for home-dwelling elderly people in Switzerland. The results can be used as a decision-making aid for future political initiatives to promote integrated care in the Canton of Basel-Landschaft. Since integrated community-based care models can extend the period during which elderly people can continue to live at home before being admitted to hospital or a nursing home, they are an important contribution to combating rising healthcare costs.

INSPIRE: Implementation of an integrated community-based care program for home-dwelling senior citizens