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New research: Models of integrated care, health and housing

The National Ageing Research Institute (NARI), in a report prepared for the Royal Commission into Aged Care Quality and Safety, finds that integrated models for care, health and housing that are embedded in the community are the most effective at empowering clients and carers to take a lead in meeting their own needs and preferences.

Incorporating literature reviews on integrated care models and consultation with key experts and providers of integrated care in Australia, Research Paper 7 - Models of Integrated Care, Health and Housing provides an overview and analysis of integrated models of care for older people, as they relate to health care, social care, and housing or accommodation in Australia.

Researchers describe integrated care as the strategies aimed at overcoming fragmentation between different services and sectors, and as a way of improving the health and wellbeing of clients, service sustainability and client satisfaction with services.

Consequences of service fragmentation can include service duplication, poor communication between service providers, a greater likelihood of error, unmet needs, client disempowerment and low satisfaction with care.

Integrated care has been a popular policy goal in Australia, but the researchers indicate that changes in practice have tended to trail behind these policy intentions. Most existing models in the community are mainly focused in the area of healthcare, rather than inclusive of care and accommodation needs of older people.

Some models wrap care around the individual, while others integrate services that address the broader population needs of a specific community, such as regional services that coordinate health, community care and aged residential services.

The community can be a geographic group, but can also be individuals connected through their social, religious or cultural communities. Holistic service approaches to older Aboriginal and Torres Strait Islander communities are one such example, as organisations in remote communities often have close connections and trusted relationships within the community.

The report discusses the need for support when older people are first engaging with services and struggling to navigate the system. One suggestion was the employment of social workers for short-term support to stabilise the situation and be a point of contact. This is an issue identified in submissions to the Commission.

The researchers note that there is often an assumption that older people have secure accommodation or assets to secure and modify their accommodation so that it is accessible as they age. This assumption is not accurate for all groups, including people who are low income renters, have insecure tenancy, or without the assets to modify their home in response to changes from ageing. The researchers conclude that co-housing is a model that could respond to this gap. Co-housing is a model of creating a community comprised of individual dwellings, with benefits of social connectedness and community life. Co-housing involves residents in the design and management of their own communities, including private residences and communal spaces.

A key finding is that care integration works best when it is a bottom-up and community-focused process, with formalised partnerships between organisations based on shared goals.

The findings from the research also suggest further attention could be given to: 

  • Supporting older people at the entry points to health, aged care and other services.
  • Promoting community-level initiatives, which engender trust and reciprocity between community members and in local services.
  • Exploring barriers faced by aged care providers in forming alliances with other organisations to provide integrated care.
  • Exploring flexible options for integrating home care into housing options that still afford clients' choice.
  • Supporting the development of co-housing models that provide secure accessible housing options that also bring connection to community as people age.
  • Ensuring transport and access for older people to existing and new services.
  • Sustainable funding that affords community-based organisations scope to innovate and proactively support older people in the community.
  • Rigorous governance that is in partnership with and/or includes community views.
  • Committed leadership that is community not profit-oriented.
  • An intergenerational life-course approach that integrates older people with their communities rather than siloed aged care.

The researchers consider that, as a minimum, Commonwealth and State Governments should consider incorporating measurable performance indicators into their service contracts so that grass-roots organisations can demonstrate how they are trying to incorporate integrated care thinking into their service models and measure the impact of these changes.

For interviews with one of the paper's authors, Dr Andrew Simon Gilbert, please contact the National Ageing Research Institute:

Rebecca Matthews: 0414 980 452 or r.matthews@nari.edu.au