Innovating long-term care systems in a comparative perspective in health emergency time: a comparison of recent developments in Italy, Spain and Germany

Abstract

Background: Long Term Care (LTC) has emerged as a key issue in national and international development strategies in recent decades. International organisations (e.g., WHO and EC) consider LTC a key issue in health and welfare strategies. The relevance of LTC is due to demographic trends, the worldwide ageing population and the related growing care demand. The implementation of Social Innovation for policies has been proposed by the European Commission since 2013 as a strategy oriented to improve the efficiency and effectiveness of policies, considering the capability to cover social needs and the available resources. Italy, Spain and Germany's LTC present similarities and differences and, for this reason, they represent two of the four existing care regimes in Europe. In these three countries, some innovations, meaning Social Innovation, have been implemented before COVID-19, affected by their specific characteristics of care models. Aims: This study aims to improve knowledge on the relationship between Social Innovation and LTC concepts and identify key characteristics for promoting innovative policies for care and social needs emerging during a health emergency, such as COVID-19. To ensure an in-depth understanding of this relationship, this PhD study compares the Italian, Spanish, and German LTC systems as case studies of different European care regimes, analysing their capability to answer to care needs even during the emergency of COVID-19 and examines the role of Social Innovations in the efficacy of LTC systems. Three specific aims contribute to achieving this general aim. Methods: The study employs mixed methods based on: (1) rapid review of literature and practices, (2) secondary data analysis, (3) qualitative analysis involving 91 experts and stakeholders in interviews and focus groups. Results: Rapid review and qualitative analysis confirm the existing relationship and identify specific characteristics and key factors contributing to the SI's success. Moreover, the rapid review of practices provides an overview of Social Innovations implemented during the COVID-19 pandemic in the three studied countries. The secondary data analysis examines the capacity of the Italian, German, and Spanish LTC systems to meet care needs even during the COVID-19 emergency, exploring various socioeconomic aspects and national resources related to the incidence and mortality during the first year of the pandemic. The quantitative results confirm the impact of LTC system characteristics on COVID-19 cases and mortality, emphasising the importance of the national containment and distancing policies enacted during the COVID-19 emergency. The results reveal differences among the three countries regarding socio-economic factors and care model characteristics, influencing the effects of COVID-19 on older individuals. Experts and stakeholders involved in the qualitative study acknowledged the differences in governance and strategic choices among the three countries, highlighting the significant role of COVID-19 in driving SI promotion. Conclusions: The policy recommendations collected in the findings push for an innovative, open, and comprehensive model of LTC, based on four key issues: a) the integration and coordination of LTC services; b) the formal inclusion of unpaid care in the LTC system; c) the valorisation of available resources for care by the spread of community care models; d) the spread of telemedicine and applied technologies as supporting tools to improve quality of care provision.