Between Social Inclusion and Exclusion: Integration of Daycare Guests in the Nursing Home Setting

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Abstract

Background and Objectives

In integrated daycare, community-dwelling older people in need of care join existing groups in residential care facilities during the day. This study focuses on how nursing home residents experience the integrative care approach, exploring opportunities for social inclusion and mechanisms of exclusion.

Research Design and Methods

A purposive sample of residents differing in cognitive capacity and level of (non)conflictual interaction with daycare guests was selected. Episodic interviews with residents ( N = 10) and close relatives ( N = 2) were conducted in 3 pilot facilities in Germany and analyzed using thematic coding.

Results

The analysis revealed different orientation patterns towards the presence of daycare guests: respondents (a) demonstrated indifference to the daycare guests, (b) saw bonding with guests as a means to connect to the outside world, and (c) perceived incompatibility between in-group and out-group. Criticisms included disruption of daily routines and loss of privacy. Most interviewees came to terms with the care situation using rational and moral arguments.

Discussion and Implications

The study reveals the importance of residents’ participation when integrating daycare guests. Institutional procedures are required to prevent exclusion of daycare guests and avoid overtaxing residents.

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Most cited references 38

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Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care

Pim Valentijn, Sanneke Schepman, Wilfrid Opheij … (2013)

Introduction Primary care has a central role in integrating care within a health system. However, conceptual ambiguity regarding integrated care hampers a systematic understanding. This paper proposes a conceptual framework that combines the concepts of primary care and integrated care, in order to understand the complexity of integrated care. Methods The search method involved a combination of electronic database searches, hand searches of reference lists (snowball method) and contacting researchers in the field. The process of synthesizing the literature was iterative, to relate the concepts of primary care and integrated care. First, we identified the general principles of primary care and integrated care. Second, we connected the dimensions of integrated care and the principles of primary care. Finally, to improve content validity we held several meetings with researchers in the field to develop and refine our conceptual framework. Results The conceptual framework combines the functions of primary care with the dimensions of integrated care. Person-focused and population-based care serve as guiding principles for achieving integration across the care continuum. Integration plays complementary roles on the micro (clinical integration), meso (professional and organisational integration) and macro (system integration) level. Functional and normative integration ensure connectivity between the levels. Discussion The presented conceptual framework is a first step to achieve a better understanding of the inter-relationships among the dimensions of integrated care from a primary care perspective.

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The effects of integrated care: a systematic review of UK and international evidence

Susan Baxter, Maxine Johnson, Duncan Chambers … (2018)

Background Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. Methods The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. Results One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. Conclusions Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. Trial registration Prospero registration number: 42016037725. Electronic supplementary material The online version of this article (10.1186/s12913-018-3161-3) contains supplementary material, which is available to authorized users.

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All Together Now: A Conceptual Exploration of Integrated Care

Dennis Kodner (2009)

Integrated care is a key strategy in reforming health systems around the world. Despite its importance, the concept's polymorphous nature and lack of specificity and clarity significantly hamper systematic understanding, successful application and meaningful evaluation. This article explores the many definitions, concepts, logics and methods found in health system and service integration. In addition to framing this evolving, albeit imprecise field, the article summarizes the main elements or building blocks of integrated care and suggests a way to address its various complexities and unknowns in a real-world sense.

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Author and article information

Contributors

Barbara J Bowers: Role: Decision Editor

Journal

Journal ID (nlm-ta): Gerontologist

Journal ID (iso-abbrev): Gerontologist

Journal ID (publisher-id): geront

Title: The Gerontologist

Publisher: Oxford University Press (US )

ISSN (Print): 0016-9013

ISSN (Electronic): 1758-5341

Publication date Collection: October 2021

Publication date (Electronic): 09 October 2020

Publication date PMC-release: 09 October 2020

Volume: 61

Issue: 7

Pages: 1030-1040

Affiliations

Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University , Bielefeld, Germany

Author notes

Address correspondence to: Kerstin Hämel, Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany. E-mail: kerstin.haemel@ 123456uni-bielefeld.de

Author information

Kerstin Hämel https://orcid.org/0000-0003-1034-2373

Gundula Röhnsch https://orcid.org/0000-0002-9894-3546

Article

Publisher ID: gnaa157

DOI: 10.1093/geront/gnaa157

PMC ID: 8437502

PubMed ID: 33034645

SO-VID: 2f5a5ccf-846c-41a1-8b72-c7f797183c8c

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 26 June 2020

Date: 24 September 2020

Date: 10 December 2020

Page count

Pages: 15

Funding

Funded by: Stiftung Wohlfahrtspflege NRW;

Funded by: Foundation of Public Welfare North-Rhine-Westphalia;

Award ID: SW-620-660-Z

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Between Social Inclusion and Exclusion: Integration of Daycare Guests in the Nursing Home Setting

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Abstract

Background and Objectives

Research Design and Methods

Results

Discussion and Implications

Related collections

Hearing Loss and Restoration

Most cited references 38

Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care

The effects of integrated care: a systematic review of UK and international evidence

All Together Now: A Conceptual Exploration of Integrated Care

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