A 10 Step framework to implement integrated care for older persons

An aging population, whose multi-morbidities and risk of frailty increase with age results in significant health and social care consumption. Increasing complexity amplifies fragmentation of care and results in sub optimal care outcomes. Ireland, in keeping with other jurisdictions seeks to implement integrated care for older persons as a policy response. There is growing evidence base supporting effective service responses for older persons. These typically include multidisciplinary, community based teams providing services in or near to the older person’s home (the ‘what’). However, examples of systemic implementation are confined to smaller regions notably in Catalonia (Spain), Scotland and Singapore. This reflects the fact that the implementation of integrated care is problematic at scale. The need to attend to methods that support high autonomy professionals tasked with local implementation (the ‘who’) is a neglected area. This is especially important in light of the fact managerial and clinical leaders already have operational and clinical imperatives to attend to. Whilst ideologically committed, the change management challenge presented by integrated care is daunting as they may lack the capacity (time, resources, structures) required to test a new care model. In addition, the change methodology fails to recognise powerful social dynamics that reflect the characteristics of a complex adaptive system (the ‘how’). This paper proposes a framework to implementing integrated care for older persons. In addition, it offers some initial empirical evidence that this approach has utility among managers and clinicians. In doing so seeks to bridge the implementation gap associated with systemic change.