Abstract
Background: For the past decades, health care has increasingly been moving from institutionalized care to care delivered in the community. However, the ageing population and the prevalence of multimorbidity have made needs increasingly complex. Effective, person-centred home care is needed to adequately address the needs of this population. We look at two core components of delivering person-centred care: needs assessment and subsequent care coordination. Internationally, countries differ in how this is organized for home care. But what aspects of the provider roles facilitate suitable needs-based, person-centered care? And what are the contextual factors that influence how we organize care coordination when working towards better integrated home care?
Audience: We invite those who are familiar with or who want to learn about how home care is organized, and different contexts and strategies for needs assessment and care coordination.
Approach: The workshop starts with a short introduction on what is care coordination and what, according to the literature, are effective strategies for proper needs assessment and care coordination in home care (10 min). We will then introduce the role of context, including health system organization, by elaborating on the role of care coordinator in Canada and the Netherlands. This portion of the workshop will also engage participants to understand where they are from and the perspectives they bring. We will dive into, among other topics, who has the mandate to do the home care needs assessment and decide on the type of home care and how initial and ongoing assessments to inform care plans are conducted (15 min). And spoiler alert: there are essential differences! For the remainder of this workshop (25-55 min), the audience will discuss in groups: a) What would work in your context? b) What would, independent of your context, be an ideal way of organizing needs assessment and care coordination for integrated home care? And c) reflect on how that aligns with knowledge of the current state. The participants will use flip charts to report their discussion. By table, the audience will be asked to present their conclusions for plenary reflections (5 min per question). The session will conclude with a summary of themes and key takeaways (5 mins).
Outcomes: With this workshop, participants will build an understanding of the breadth of approaches to needs assessment and care coordination and the role context plays in how this aspect of care can be effective. We will support the audience to reflect on what it means for integrated home care to have different ways of organizing it.