Living well at home - integrated care for older people in ireland

Abstract

Introduction: An ageing global population has led to increased costs for health and social care delivery. This has created a move away from acute hospital to integrated care across and between the acute, primary and community health and social care systems. In Ireland, Sláintecare, the ten-year plan to reform healthcare, has co-produced, integrated, person-centred care embedded in its policies1. This research looks at what is important to the older person, their family/carers and, the health and social care practitioners on the pathway from hospital to home, enabling the older person to remain and be cared for at home.

Methods: On-line semi-structured interviews were undertaken with six clinicians involved in the care of older people plus two representatives of third sector organisations. The data was manually transcribed to gain a greater understanding of the content and context2. Analysis was completed through theoretical sampling and comparison. The findings informed a focus group of five older people, facilitating a conversation around what was important to them- in hospital to prepare for discharge; at discharge and, at home to enable them to stay well. Data was analysed for recurrent themes at each stage, compared to interview data and common themes extracted.

Results: Communication between disciplines and practitioners within and across the acute and community healthcare systems is important to the delivery of integrated, person-centred care. Timely relevant information and actively listening to the older person’s voice is crucial at all stages. In line with research by McCormack and McCance3, developing a culture of person-centred care, where all those delivering and receiving care are treated with respect and dignity is important at all levels of healthcare provision and across all organisations. Community is seen by all as important to enable and empower older people to age well at home. In Ireland’s Integrated Care Programme for Older People (ICPOP) the ‘Living Well at Home’ section is viewed as essential in caring for older people, particularly the social prescribing and facilitating social connections elements.

Conclusions: The ‘Living Well at Home’ section of ICPOP demonstrates an acceptance that health and social care are more than medical. Engagement with community supports is an important aspect of its delivery. Active listening and communication between and with stakeholders is an essential part of person-centred integrated care.

Implications: While funding for ICPOP has increased4 and the roll out accelerated, the ‘Living Well at Home’ section, acknowledged by all as essential, has not received the same consideration. To provide person-centred integrated care, as envisaged by the ICPOP this needs addressing.