Great Expectations of Integrated Care : an Investigation of Assumptions Regarding the Impacts of Integrated Care for Frail Elderly People on Formal and Informal Caregivers

Frail elderly people are increasingly being cared for in their own homes by both formal and informal caregivers. Integrated care models are therefore being developed to better coordinate formal and informal care for frail elderly people in communities. However, much remains unclear regarding the impacts of integrated care delivery on formal and informal caregivers. The aim of this dissertation was therefore to investigate the three main assumptions regarding the benefits of integrated care on formal and informal caregivers, i.e., that integrated care for the frail elderly (1) safeguards informal caregivers against the negative impacts of caregiving; (2) improves the work processes and experiences of formal caregivers; and (3) improves the interaction between formal and informal care over time.

These assumptions were investigated in the real-life setting of an integrated care intervention for community-dwelling frail elderly people in the Walcheren region of the Netherlands. This intervention, the ‘Walcheren Integrated Care Model’ (WICM), consisted of the following evidence-based elements: a single entry-point, proactive frailty screening, comprehensive needs assessments, case management, multidisciplinary team meetings, protocols and treatment plans, a shared information and communication system, task specialization and tasks delegation, and the creation of a geriatric care network with a formal steering group.

The results show that integrated care for the frail elderly can be expected to safeguard informal caregivers against some negative impacts of caregiving, but also that improvements for formal caregivers and formal-informal care interaction should not be readily expected. It is concluded that, as yet, most expectations regarding the benefits of integrated care for formal and informal caregivers remain unjustified.