Organisational Structures
Formal Care in the Home and Community
flexible and adaptable services to suit individual needs and individual lifestyle
LAND / ORT: Switzerland
Keywords: Service integration, intermediary care structures, community, territorial networks, good practice
Keywords: Service integration, intermediary care structures, community, territorial networks, good practice
Cité-Générations - A care network including sheltered housing
Summary
Cité-Générations is an ambitious project for the construction of a multi-practitioner health centre including sheltered housing for dependent older people, a range of diagnostic health services, multi-generational housing, child care, and offices for home care and other specialized services. Construction is currently under way, services will open in 2011.
The project has been developed by a team of GPs, a geographer/city planner and an architectural bureau. Its main goal is to transcend the fragmented, poorly coordinated functioning of health and social care services for older people in canton Geneva. While a high concentration of services is available, attempts to organise service delivery into territorial networks have been thwarted by financing mechanisms and by the inertia of political and service delivery organisations. CG/RS is a creative, innovative project that places GPs at the centre of the network and proposes a model inspired from Canadian and American examples such as PRISMA and S/HMOs.
What is the main benefit for people in need of care and/or carers?
The main benefit for people in need of care and for carers is simpler and more unified access to information and services in their neighbourhood.
What is the main message for practice and/or policy in relation to this sub-theme?
It shows that even in a system of care where coordination is difficult and providers are hard to unite around a common project, a policy initiative can be implemented at the local level.
Warum wurde diese Initiative implementiert?
The main focus of the project is the creation of a multipurpose focal point for territorial health and social care services and as a support centre for LTC services in the area. The densely populated (60,000 inhabitants), culturally diverse suburban Geneva community of Onex, in which it will be implemented, is typical of an evolving urban environment with increasing numbers of older people. Several reports proposed a diagnosis of current gaps, criticised excessive focus on the construction of new nursing homes and insufficient plans for sheltered or adapted multigenerational housing. A wider range of support option and increased and direct involvement of local GPs as well as home care services will be better served by a visible integrated option and structure opportunity for communication between professionals.
Target groups are vulnerable older people as well as people suffering from chronic illness necessitating coordinated and reliable quality health care.
Beschreibung
The CG/RS project was initiated and formalized in 2006 by a GP and public health specialist involved in one of the first and largest GP network/managed care organisations in Geneva. It involved extensive planning, applications for funding and intensive communication efforts to persuade cantonal and local authorities and to explain the rationale, expected benefits and exemplary character of the experiment proposed. International publications helped, as well as lobbying of the local medical community, within which the Delta network was already well known and respected.
In 2010, at a time when several reforms have run into difficulties in Geneva despite legislation favouring care networks and setting forth plans for more integrated services, CG/RS represents a concrete advance attempting to bypass political and financial blockages and difficulties in implementing a canton-wide assessment and coordination network.
Welche Effekte wurden erzielt?
Potential impacts may be found in the areas of reducing gaps between services in the LTC field in the area, allowing increased communication between providers, and supplying structures (sheltered housing in the community) currently in very short supply. Mainstreaming may be difficult as the project requires specific funding, although future operations should be financed in traditional ways, a sizeable initial investment is required for common offices and housing structures. Similar initiatives are planned in a smaller community in Valais, with an explicitly intergenerational intent.
The main benefit of CG/RS may lie in its involvement of GPs from the planning stages and from the recognition that proper coordination with other LTC services necessitates teamwork including primary physicians, who are responsible for formally requesting home health care services but are rarely involved in hospital discharges, temporary nursing home stays and coordination with other components of the LTC system.
As the project relies on international examples and networks and collaboration models, formal evaluations and comparisons will be built into the project.
Worin bestehen die Stärken und Schwächen der Initiative?
The project cannot be evaluated yet as it is not fully implemented. Difficulties may arise in changing the habits of local professionals and overcoming the barriers linked to separate funding sources for different services. Considerable investment is needed for the project, yet several aspects – particularly GP involvement – could be imagined without the sheltered housing component.
Evaluation will be ongoing since the project is specifically designed as a pilot, with links not only to the medical but also to the urban planning academic communities.
Impressum
Autor: Elisabeth Hirsch Durrett, University of Applied Sciences, School of Social Work éésp, Lausanne Switzerland (http://www.eesp.ch/)Reviewer 1: Georgios Kagialaris
Reviewer 2: Kerry Allen
Verified by: Dr P. Schaller
Externe Links und Literatur
- Cité-Générations (all recent publications about CG/RS are referenced on this website)
