Abstract

Background and objectives: The EFFA includes three core domains and one cross-cutting domain; sequenced to start with people as the guiding focus (their needs; the determinants of health; and their involvement as engaged and empowered individuals in their health and health services). The second domain – Services – signals those key properties of services to be improved upon, with specific decisions on the design and focus taking direction from the specific context of health needs and previous decisions taken. The third domain – Systems – aims to find the alignment as mentioned with other health system functions at the unique interface between services and the health system for sustainable, system-wide change. Throughout, a change process is at play, having a key role in first building momentum but also implementing new practices and further rolling-out piloted ideas and projects.

Results: The vision embodied by the EFFA IHSD as well as its structure are well adapted to reflect the main challenges and characteristics of long-term care systems, and no changes in the core domains of the framework resulted as necessary. However, some adaptations are required in order to reflect the specificities of long-term care. First and foremost, the role of family and other unpaid caregivers as co-producers of care but also as care users themselves requires that they be accounted for both as generators of demand and of supply of care. In addition, fragmented funding and governance structures render long-term care systems slow to change and adopt innovations and difficult to manage efficiently. Finally, the challenges of the LTC workforce and the redefinition of care roles and necessary skills generates structural weaknesses in long-term care systems and threaten sustainability. Using the EFFA IHSD, one can assess a country’s stage of integration from segregation, through linkage and coordination up to integration, by assessing progress in 5 key dimensions of service provision: Design of care mix; Organization of providers; Management of services; Continuous performance improvement and Support for family and other unpaid care.

Conclusions: The EFFA IHSD is a powerful instrument for analyzing the level of integration between health and social care service delivery in long-term care settings and to provide a framework for recommendations for change. With only marginal adaptations, it can provide crucial insights into the functioning of long-term care systems, as well as into the barriers and facilitators for further integration of care pathways.