Case management as social innovation in long-term care: Lessons from Italy
Georgia Casanova | INRCA – National Institute of Health & Science on Ageing
Background: In the last decades the debate on policies to address the challenges posed by population aging has led to a change in the approach used to tackle this issue, paying more attention to the impact this phenomenon might have on society and on lifestyles along the life course (Leichsenring et al., 2013; Walker & Foster, 2013). This includes the widespread use of keywords such as ‘active ageing’ and ‘social innovation’ in formulating policies, thus underlining the emergence of innovative strategies to face the new challenges deriving from changes in sociodemographics and societal needs (European Commission 2012). In the Long-Term Care (LTC) sector, social innovation has been focussing on attempts to improve the quality of life of frail older people and of their informal caregivers. Although many good practices have been activated in this respect, no systematic review of these experiences has yet been carried out to understand what are the main barriers and drivers of social innovation in this field, and to promote the mainstreaming of prototypal actions into systematic change. In a recent study on the Italian context (Schulmann et al. 2015, Van der Heide et al 2015) however, case management has been identified as one of the main social innovations observed, involving many important elements for LTC development: multidisciplinary staff, integration between health and social care, stakeholders coordination, ICT support.
Objective: This presentation aims to illustrate why case management represents one of the main social innovations implemented in the Italian context, what are the policy sectors involved and which further steps are more urgently needed in the future.
Data and methods: Starting from the findings reported by the research carried out within the MOPACT project in the field of LTC (http://mopact.group.shef.ac.uk/research-fields/social-support-and-long-term-care/), this presentation is based on the systematic review of Italian data collected via national focus groups, experts interviews and case studies. The study considers drivers, barriers and transferability as key dimensions of analysis, and the micro, meso and macro dimensions as a tool to elaborate policy recommendations.
Results and policy implications: Case management represents a social innovation promoting a paradigmatic shift in LTC delivery, from acute care to prevention and from a system-centred to a user-centred approach. ‘Integration’ and ‘coordination’ become key in this respect, as does the focus on shared skills and responsibilities among all stakeholders (professional and informal carers, local actors and institutions). Although LTC fragmentation represents still a main barrier to the implementation of this approach in Italy, the existence of local experiences in this area underlines some promising perspectives for their scaling-up in this country. To this purpose, however, following strategies become crucial: to facilitate the transferability of experiences (e.g. by supporting the collaboration of micro-level initiatives into meso-macro level networks); to disseminate ICT use as a key-driver to improve quality care and working conditions; to promote interprofessional, inter-institutional and inter-stakeholders collaboration; to strengthen the development of a LTC system identity that includes prevention as a key component.