How can the settings used to provide care to older people be balanced?

Key messages

Policy context

• All European countries project dramatic growth in the costs and use of formal and informal care as the number of dependent older people with long-term chronic illnesses rises.
• The rising future financial burden of care for older people requires the optimum use of resources with care settings tailored and customized to both individuals and communities.
• The projected decline in the supply of informal care will require investment in home-based self-care and increased caregiver support in the home environment.
• The projected increase in the utilization and cost of institutionally based care can be partly offset by investment in formal home-care and home-environment alternatives.

Policy options, dividends and implementation

Creating an intellectual platform for planning

• Policies that promote independence and prevent people with common chronic conditions from deteriorating can be effective in containing costs and promoting health and well-being.
• Planning care requires more sophisticated planning processes that combine population-based needs assessment, resource allocation and the customization of care.
• Eligibility of access should be sensitive to individual needs and linked to a more integrated and personalized set of care providers.

Developing arrangements for service delivery

• Individual needs should be assessed at a single coordinated point of adjudication and be comprehensive and multidisciplinary. Combining individual needs assessment with broader (national) eligibility criteria has advantages.
• Individualized care planning should enable services to more closely match needs and may limit the growth in costs. Information hubs on locally available services enable older people, caregivers and people providing home care support to tailor care packages effectively.

Establishing client-based financial arrangements

• Consumer-directed payments can enable individualized care but require support structures that help optimize appropriate choices and enable support to be given to caregivers.
• The role of informal caregiving needs to be formally recognized and supported through financial incentives and caregiver-support programmes.

Developing incentives for informal care

• Fragmented and episodic care should be replaced with integration and coordination across the spectrum of care providers, and an individualized care pathway should be established at the point of assessment. This may be encouraged through funding and commissioning processes that yield incentives to integrate service delivery from a network of care providers.