INTEGRATED LONG TERM CARE FOR VULNERABLE ELDERLY AS A COMMON CHALLENGE TO DEVELOPED COUNTRIES – INSIGHT FROM THE RESEARCH PROJECT POLIA INLOVE (Blanche Le Bihan and Alis Sopadzhiyan)

General Context– Why is comparative research on coordination and integration policies in the elderly care field needed?

As a result of increased life expectancy, policies regarding old people in need of care (also referred to as long term care policies) represent a major public health issue in Europe and in all developed countries[1] (OECD 2011). The growing proportion of people aged 80 + years raises the question of their demand for daily health and social care, in a context where care traditionally provided within the families is increasingly questioned. Public authorities have to cope with different challenges: a political one, because governments have to meet the growing needs of families and come up with appropriate answers; an economic one as the solutions proposed have to fit a context of strong budgetary restriction; and a social one, since what is at stake is to fight against inequalities in access to services.

In this context, policy measures in LTC have progressively aimed at facilitating care arrangements combining formal and informal care and/or fostering market-based care provision. Improving coordination between health and social care professionals and the relativesinvolved in the caring activities of old people is presented in many countries as a solution to improve elderly care.

In France, specific policy measures have been implemented to facilitate the coordination or integration[2] of care for older people. The stress has been put recently on this issue with the third Alzheimer Plan (2008-2012) and the creation of a new and dedicated scheme, with an explicit aim of facilitating integration of health and social elderly care: the MAIAs.[3]Nevertheless, the articulation of the interventions of professionals coming from the health and social sectors and the integration of their actions are challenged by the financial and service fragmentation between and within each sector, as well as by the diversity of the professional and institutional actors involved[4]. As a consequence, the creation of this new scheme seems to have introduced more confusion for the care users.

The POLIA INLOVE Project – POlitiques et dispositifs d’Intégration pour l’Accompagnement des personnes âgées enperte d’autonomie en Europe, une comparaison européenne / Integrated Long term care for Vulnerable elderly in Europe – was designed in a context of implementation of the MAIA scheme in France in order to address different and sometimes paradoxical issues:the necessity, shared by all actors, to coordinate and integrate the long term care sector, the difficulties to reform the care system, to meet the requirements of the different actors and to resolve the existing tensions and complexities.The ambition of the POLIA INLOVE project is not only to identify the factors facilitating or impeding integration/coordination at the local or national levels, but also to compare this recent French initiative to similar experiences led in other European countries. Indeed, very little comparative analysis has been conducted in order to study those common coordination/integration issues, the specificities of each experience implemented at local levels, as well as the national context in which they have developed. This project aims at filling this gap by analysing, in a comparative perspective, the situation in three European countries: France, the United Kingdom and Sweden.

The POLIA INLOVE Project – Funding and Research Team

The POLIA INLOVE Project obtained funding in 2013 from the first call for projects of the IDEX-USPC for the support of innovation research projects. The University of Sorbonne Paris Cité (USPC) is a higher education and research alliance bringing together four Parisian universities (Sorbonne Nouvelle – Paris 3, Paris Descartes, Paris Diderot et Paris 13) and four higher education and research institutes(Institute of Physics of the Globe (IPGP), National Institute of Oriental Languages and Civilizations (INALCO), Sciences Po Paris and the French School of Public Health (EHESP).

The project associates researchers from both the French School of Public Health (EHESP) and Science Po Paris. The research team includes the two main scientific investigators Blanche Le Bihan[5] and Léonie Hénaut[6], and two other researchers, Marie-Aline Bloch[7] and Alis Sopadzhiyan[8]. Furthermore, internationally recognised experts in the field of elderly care have been associated to the project: Marta Szebehely[9], Lennarth Johansson[10], PärSchön[11]in Sweden and David Challis[12] in the UK.

Goals and Preliminary Results

The general ambition of the POLIA INLOVE project is to contribute to the debates on elderly care policies by analysing – in a comparative and qualitative perspective – the integrated care policies experienced in the three European countries studied (Sweden, UK, and France). Based on the literature and on the French experience characterised by an important fragmentation of its elderly care sector, our hypothesis is that coordination/integration measures areconsidered as key elements to improve the elderly care system. Nevertheless, the way in which issues of coordination and integration are dealt with in the overall field of elderly care policies, on the one hand, and the concrete experiences of coordination and integration for both professionals and users, on the other hand, might be specific in each national context. The project thus aims at understanding how, when and if coordination and integration have been constructed as a public issue in the elderly care sector; how specific measures have been organised and implemented; and what is the impact of the different measures on both the organisation of elderly care sector and the everyday life of care users.

The analysis is led at two levels:

  • The national policy making level with the objective of identifying the main steps and turning points of the development of coordination/integration issues in the national trajectory of elderly care policies.This should inform us on the conception of the policy which is led in terms of coordination and integration and help us to define more precisely what is behind these notions.
  • The local level, in order to investigate in depth the implementation of the policy measures and analyse the practices of professionals implied in the care towards older people.

Interviews with policy makers and experts in the field have been led in a first phase of the research to study both the orientation of the coordination/integration policy measures and their conception in the three countries. Preliminary results confirm the hypothesis of a common trend towards the development of coordination/integration schemes in order to improve the continuity of care to older people and their families.The differences identified concern both the objectives explicitly formulated by the policy makers and the mechanisms they are based on.[13]

The second level of analysis concerns the in-depth and comprehensive study of the implementation of national programs and schemes: the MAIA schemesin France, the Integrated Care Pilot in the North-West of London in the UK, andthe local integration model TioHundra implemented in the municipality of Norrtälje in Sweden. The empirical study is based on qualitative interviews with local decision makers, organisations and professionals and aims at investigating the variety of solutions experimented in the three countries, and the way local configurations and trends identified at the national policy making level interact with this implementation process.

 

[1]OECD (2011): Help wanted? Providing and paying for long-term care, Paris, OECD

[2]The two terms – coordination and integration – are referred to according to the scheme, it is part of the project to analyze what conception of care organization is behind these notions.

[3]Initially MAIA stands for “Maisons pour l’Autonomie et l’Intégration des Malades Alzheimer” (Homes for the Autonomy and the Integration of Alzheimer’s Patients or associated disorders), but itsmeaning has recently been modified to “Méthode d’action pour l’intégration des services d’aide et de soins dans le champ de l’autonomie” (Method for the action and the integration of health and social services in the autonomyfield) in order to extendits action to all old people in so called « complex situations ».

[4]Bloch M. A., Hénaut L. (2014) : Coordination et parcours. La dynamique sanitaire, médico-sociale et sociale, Dunod.

[5]Political scientist, Professor at the French School of Public Health and researcher at the Centre of Research on the Political Action in Europe (CRAPE, UMR 6051).

[6]Sociologist, Researcher at CNRS, Centre of Sociology of the Organizations (CSO, UMR 7116).

[7]Management Scientist, Professor at the French School of Public Health and researcher at the AE MOS.

[8]Political scientist, Post-doc researcher at the French School of Public Health and at the Centre of Research on the Political Action in Europe (CRAPE, UMR 6051).

[9]Professor of Social Work, Stockholm University.

[10]Researcher at the Ageing Research Center, Stockholm.

[11]Researcher at the Ageing Research Centre, Stockholm.

[12]Professor of Community Care Research/Director PSSRU, Manchester.

[13]For further details see Sopadzhiyan A.and Le Bihan B., 2014, “Constructing elderly care integration and coordination as a policy issue. Evidence from France and Sweden”, The International Conference on Evidence-based Policy in Long-term Care (31/08 – 3/09/2014), International Long Term Care Policy network, London School of Economics and Political Science (LSE), London, 1st September 2014.

Blanche Le Bihan, Phd in political science, Professor at the French School of Public Health, Researcher at the Research Centre on Political Action in Europe (CRAPE – UMR 6051)

Alis Sopadzhiyan, Phd in political science, Post-doc Researcher at the French School of Public Health, Researcher at the Research Centre on Political Action in Europe (CRAPE – UMR 6051)

 

Information Contact: Alis Sopadzhiyan, Email : alis.sopadzhiyan@ehesp.fr; Telephone : +33 (0) 2 99 02 26 37 ; Adresse : EHESP, Avenue du Professeur-Léon-Bernard , CS 74312, 35043 Rennes Cedex, France