How A Swedish City Is Bridging The Gap Between Social And Healthcare For The Elderly

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Coordinating social and healthcare for the elderly its a critical challenge. The goal of care coordination is to ensure that all those responsible for the health and wellness of an older person have a clear understanding of their roles and their shared responsibilities.

Even in a country like Sweden, which has a strong healthcare system and which dedicates significant money and time to improving the system, care coordination is a challenge. This is in large part because the responsibility for healthcare is divided between two levels of local government – the county and the municipality – and neither is fully informed about  what the other is doing. Counties in Sweden are much like our states and municipalities like our cities. The counties deliver primary healthcare services and the municipalities manage social and long term care, including elder care.

In Sweden, it is not unheard of for a single person to have up to sixty different healthcare providers from different clinics and organizations, across both levels of government. In an ideal healthcare system, the primary healthcare provider would coordinate all care, keeping track of the person’s health information and keeping every provider up to date on respective roles and the patient’s health. Because of the healthcare division in Sweden, this rarely happens. A 2015 Commonwealth Fund survey of primary care physicians in Sweden and nine other countries found that fewer than half of primary care physicians in Sweden coordinate care with homecare and other social services.

A senior physician in Sweden who specializes in geriatric care puts it like this, “Imagine that the two sides start building a bridge to connect the two countries. Both sides do an amazing job. Both sides are competent. However, the two sides of the bridge don’t meet in the middle. You are left with two disconnected half bridges. This illustrates our healthcare system. We each work in silos. Each silo consists of competent healthcare providers working independently when what we need to do is work together.”

In Uppsala, a municipality of around 200,000 people near Stockholm, they have built a new structure to bridge the care coordination gap. The municipality created a central care coordination group for elder and long term care, which acts as a person’s surrogate primary care physician. The group includes doctors, nurses, occupational therapists, and support agents from the municipality. Instead of being directed by the primary care physician, this core team acts conducts all care planning meetings and updates the primary care physician on progress. This alleviates the burden on primary care physicians, who are employed by the county and rarely have time to attend, much less manage, care planning meetings for each of their patients in need of long term care or social services.

Primary care physicians are invited to participate to the maximum extent possible and are welcomed at all care planning meetings and into all care discussions. If they can’t attend the meetings, they are kept up to date on all developments by a member of the central care coordination team.

The Uppsala example is an important one. Every country has bureaucratic and administrative roadblocks that prevent efficient delivery of care for young and old alike. Uppsala care providers knew that policymakers wouldn’t be able to change the way care is divided between the municipality and the county. Any legislative change would move far too slowly for patients in need. Instead of accepting the status quo, local government leaders and healthcare providers worked together to restructure the way primary care physicians and specialized care providers communicate and interact. By doing so they transformed care coordination for the elderly and those in need of long term care. What Uppsala shows us is that local innovations can deliver remarkable results. Next in the series, we’ll talk about how technology can further improve care integration.