Integrated access point for older people

Why was this example implemented?

Acknowledging regional directives, Local Health Authority (LHA) n. 10 (Veneto Orientale) planned to establish an Integrated Access Point in each of its three Social and Health Districts (SHD), linked with the Municipalities of the area. These unique points of access aim to promote and facilitate equal access and continuity of care for older people in  health and social services:

• Many frail older people are not able to gain access to services as they simply do not know about them. The Integrated Access Point provides information to citizens about opportunities in the local area and facilitates access procedures, e.g. by helping to fill in forms and by forwarding them to the competent body.
• As hospital and home care services often operate independently from each other, the Integrated Access Point promotes integration between hospital and home care, health and social services, and facilitates continuity of care.

During the first phase of the Integrated Access Point the main users have been frail older people in need of LTC services (e.g. Alzheimer’s patients, terminally ill people, etc.) and informal carers (families, friends, neighbours, migrant care workers, volunteers, etc).

During the next implementation phase, the Integrated Access Point will put more emphasis on networking with health care staff of the LHA n. 10, hospitals, social workers of municipalities, general practitioners, as well as health and social care staff from residential and semi-residential facilities. They will thus improve information about all services and simplify access procedures to the whole network of health and social services in the area.

Description

Integrated Access Points have been opened in branch offices in each of the three Districts of the LHA n. 10 (Veneto Orientale). Affiliate branch offices have also been established in each hospital to facilitate protected discharge, i.e. a managed transition from hospital to care at home, supported by appropriate services.

Staff of the Integrated Access Point provide information and receive requests for health and social services in the area covered by the LHA and for social services in each of the corresponding municipalities (LHA and municipal boundaries do not always match). Access points work on three different levels covering front-office, back-office and monitoring as well as coordination functions.

Front-office tasks comprise:

• first reception, information, support and counselling
• first assessment by a social worker to activate access procedures including the activation of the multi-professional evaluation team and integrated services
• support in filling-in forms and collecting requests for access to LHA integrated services, including transfer of information and request  for  access to municipal social services
• protected discharge including the activation of the multi-professional evaluation team and integrated services
• implementation of procedures to make every intervention provided by  different services traceable, i.e. by linking data from hitherto distinguished databases for home care and requests for prosthesis and/or other auxiliaries.

Back-office tasks include:

• collecting information about service providers
• simplifying bureaucratic procedures
• monitoring, i.e. statistics about activated interventions, data collection and analysis, etc.

Coordination and linkage tasks consist of:

• managing relations with internal and external services of the local health system, i.e. both public and private services in the area
• linking competent bodies and services for access procedures and continuity of care
• promoting public events and initiatives about older people

The Integrated Access Points’ team is composed of one full-time social worker (36h/week) who works as coordinator, and three additional full-time social workers (36h/week) that have front and back-office functions. The catchment area of the LHA n. 10 covers 260,000 inhabitants, of which about 40,000 potential users above the age of 65. Unfortunately no data about actual users are available.

Annual total costs of an integrated Access Point (Jan-Dec 2010) is about €270,000 (€150,000 for Human resources; about €14,000 for Equipment; about €50,000 for ICT hard and software; €18,000 for 2 cars; €30,000 for Training course for staff; about €12,000 for other costs).

What are/were the effects?

The Integrated Access Point has been implemented for a short time only (since 2009) so there is limited evidence on its impact on integrated care and continuity of care.

However, establishing an Integrated Access Point requires a new organisational structure, which necessitates the setting up of  a unique access point for users where staff can directly activate counselling, assistance and care pathways, rather than users having to negotiate different health and social care offices.

The Integrated Access Point aims to make every citizen aware of his/her rights and of the opportunities that the service network offers, thus promoting and enabling access. The user is seen as an active and participative subject, involved in the planning and implementation of personalised service arrangements, rather than being a passive recipient of services planned and delivered by others. The LHA n. 10, through the Integrated Access Point, is thus trying to promote citizens’ involvement by enabling choice and self-determination.

Staff of the Integrated Access Point collects, collates and provides data about activities and requests from its catchment area, both in qualitative and quantitative ways. Based on this information, political and institutional decision-makers can improve their response to citizens’ needs and prevent crises.

According to the legislation of the Veneto Region, the project is going to be rolled-out to the whole region. Furthermore, 17 out of the 21 Italian regions have included the Integrated Access Point in their regional social and health plans. On a National level, an agreement of the “State-Regions Conference” on 25^th March 2009 called for regional governments to improve integrated care for older people by promoting the creation of unique access points (PUA in Italian language) in local areas.

First tangible results of the Integrated Access Point in LHA 10 Veneto Orientale concern the simplification and improved user-friendliness of the assessment procedure for disability certification that links the ‘Prosthesis and Auxiliaries Office’ with the Provincial Board of the National Institute for Social Security (INPS). The next step will be to determine comprehensive access rules to home care services for the entire catchment area.

What are the strengths and limitations?

Strengths

• It makes older people aware of their rights and of the opportunities offered by the service network.
• It increases the cooperation and transfer of information among competent bodies in order to plan continuous care and assistance.

Weaknesses

• Lack of ICT integration – there are still different non-integrated  systems running even within the LHA n. 10 itself.
• Superficial knowledge of local and informal resources (volunteer associations, migrant care workers) – Staff need to have a better knowledge and overview of informal resources available for older people in the area.
• Lack of information and proper training for professionals. Each professional who works or gets in contact with older people, e.g. GPs and hospital staff, needs to know about the existence of the Access Point and its functioning in order to optimise collaboration within the network.

Opportunities

• Introduction of new and mutually agreed procedures for access to services and continuous care.
• Introduction of new tutoring activities in social and health care services. Staff aim to monitor interventions for frail older people to facilitate reporting of potential shortcomings and the need for improvement.
• Improving synergy among different services in order to create continuity of care.
• The Integrated Access Point is an important opportunity to develop and promote innovations within the professional culture of the entire network.
• The model of the Integrated Access Point in LHA 10 Veneto Orientale is transferable to the whole region and can also be transferred to other national or international contexts.

Threats

• Lack of precise directions and guidelines by LHA 10 Veneto Orientale‘s management about coping with ‘non-pertinent’ requests. Clear guidelines concerning, for instance, referral to other entities may prevent “non pertinent” requests.
• The managerial, organisational and cultural models of the LHA, its districts and the municipal level are not completely integrated yet.

Credits

External Links and References

Peer reviewed journals/systematic reviews:

• Bellentani M., Simonetti R., Gugliemi E. (2009) ‘Il punto unico di accesso: scelte regionali’, pp. 17-22 in: Prospettive sociali e sanitarie, n. 12.

Policy documents:

• Veneto Region, Decree n. 39/2006
• Decree of the Director General of LHA 10 Veneto Orientale n. 668/2006: Local Plan for home care; DGR 39/2006: Il sistema della domiciliarità. Disposizioni applicative.
• LHA 10 Veneto Orientale: Piano Attuativo Locale (PAL) per le cure primarie – luglio 2009
• LHA 10 Veneto Orientale: Piano Locale per le persone in condizione di non autosufficienza (Piano per la residenzialità)
• LHA 10 Veneto Orientale: Piano Locale della domiciliarità 2007-2009
• LHA 10 Veneto Orientale: Piano di zona Veneto Orientale 2007-2009 – Cap. Anziani e non autosufficienza
• LHA 10 Veneto Orientale: Del. DG 393 del 16/12/2009 “Piano Locale della domiciliarità 2007-2009. Approvazione progetto Sportello integrato: implementazione nuova organizzazione”
• LHA 10 Veneto Orientale UOC Anziani e Disabili: Piano locale della domiciliarità. Sportello integrato: implementazione nuova organizzazione

 Unpublished/web-based documents (policy documents, practice reports):

• Report: Integrated point of access in LHA 10 Veneto Orientale (Italian language – Confidential report)