Addressing Long-Term Care as a System — Objectives and Methods of Study

Abstract

One of the major achievements of humanity over the past 50 years has been the steadily rising life expectancy to which health systems all over the world have significantly contributed. Popular media coverage of this advancement however has tended to neglect the benefits of scientific progress that improves human longevity and instead portray catastrophic scenarios such as ‘demographic nightmares’ or the ‘ageing tsunami’. It is undisputed, however, that societies are struggling heavily with the consequences of demographic changes, particularly with respect to health and social care needs of a rising proportion of older people across Europe. The urgent need for policy and practice to respond to this demand has been the main trigger for the authors gathered in this book to elaborate on issues to improve and further develop long-term care (LTC) for older people in a systemic perspective. LTC in general remains a fragmented area; there is a lack of shared definitions within and between European countries, and in many countries it is only just beginning to emerge as an idea at the interfaces between informal and formal care, and between health and social care services. The economic crisis enveloping Europe with its consequent restrictions on public expenditure may also stifle momentum towards improvement and much needed change in LTC services. A number of other key challenges facing policy and practice in this area have been well documented, focusing for example on the lack of clear governance and finance mechanisms, increasing reliance on untrained migrant care workers, poor coordination between services, the burden on informal carers, and the lack of user involvement in care (European Union, 2012; Colombo et al., 2011; Bettio et al., 2006; Costa-i-Font and Courbage, 2011; Lamura et al., 2008; Bewley et al., 2011; Hofmarcher et al., 2007).