Building on integrated acute care for older people: strengthening the position of long-term care organizations

Background: Integrated acute care for older people (IACOP) focuses on preventing unnecessary hospital admissions and on supporting efficient and timely discharge from acute care. Long-term care organizations play an increasingly important role in IACOP by assisting in triage at the hospital, providing inpatient (intermediate care beds) and outpatient (acute community care) intermediate care. In the Netherlands, IACOP are traditionally arranged and coordinated per region.

 

To make IACOP more efficient and sustainable, regions are seeking to align their processes. However, variations in bed capacity and workforce availability, population needs and characteristics and organizational cultures makes alignment challenging. This study explores perspectives of directors, managers and physicians on how to align these IACOP processes across three regions in the South of the Netherlands.

 

Approach: In this study ‘The World Café’ method was used. This method encourages a collaborative dialogue on questions that matter. Participants were professionals from long-term care organizations in the south of the Netherlands providing inpatient and outpatient intermediate care. Professionals were working as either elderly care physician, manager, medical director or CEO.

 

Topics discussed during the sessions focused on 1) defining the evolving role of long-term care organizations in IACOP; 2) adopting new perspectives on collaboration and shared responsibility; 3) balancing cross-regional collaboration and uniformity in triage and coordination versus local autonomy 4) identifying the desired future position of long-term care organizations within the acute care chain.

 

Results: Forty participants attended the sessions. They emphasised that cross-regional collaboration is essential to ensure continuity and accessibility of acute elderly care. To achieve this, clear agreements, a shared language (e.g. transparency on definitions and their meaning per region) and true commitment at managerial level are needed. One triage moment at ED was seen as key (preferably by nurses or elderly physicians working in long-term care with relevant expertise) to assess which place/bed is the best for this specific patient —followed by direct transfer without repeated triage by individual organizations. Participants stressed that there should be a shared vision that client’s needs are more important than organizational interests, and that this should be supported by joint rules and shared capacity management.

 

Implications: Cross-regional alignment in acute long-term care depends not only on structures but also on trust, shared understanding and collective ownership. Strengthening collaboration across LTC organisations in IACOP can reduce duplication, improve patient flow and promote a more person-centred approach. The World Café approach proved valuable in building mutual insight and joint commitment towards this sustainable, integrated acute care for older people.