Despite the growth in community-based integrated care for older people (CBIC)
internationally and in Ireland, there remains substantial difficulties in supporting older
adults in small-scale peripheral places, where ageing, inequalities and needs are
most evident. Comprising of rural, shrinking small-town and intra-metropolitan areas,
peripheries embody significant constraints and opportunities, and complicate
challenges around implementation dissonance, and digital integration. Yet, the
effectiveness of CBIC models have not been evaluated, nor their attributes
investigated for peripheries, in Ireland or elsewhere. CBIC innovation, thus, critically
lacks evidence, undermining the potential for spatially just CBIC.
In conjunction with the Health Service Executive (HSE), CONTEXT-care aims to coproduce
a person- and place-centred CBIC meso-level ecosystem model, which
accounts for dissonance and digital deficits, and advances the equity of ageing-inplace
for older people in peripheries. In doing so, CONTEXT-care will identify,
digitally-supported, CBIC solutions for care mix, governance and workforce
integration.
CONTEXT-care employs an interdisciplinary mixed-method embedded case-study
design, that embeds lived-experience perspectives in the study. CONTEXT-Care
incorporates multiple-levels (international; national; local) and includes: a systematic
review, international and national stakeholder interviews; national care coordinator
survey; national periphery preference survey; and within two local case-study sites,
discussion forums and experiential care interviews. A multistakeholder participatory
democratic platform will help validate the findings and coproduce the meso-level
CBIC ecosystem model.
CONTEXT-Care will drive a strategic assessment of community-care provision and
integrated care roll-out for older people in peripheries within HSE West/North-West. It
will provide on-the-ground learnings and lived experience evidence that will help
refine/re-design HSE structures to support integrated provision, at granular local
levels – providing the eco-system CBIC model for wider application. This will
maximise the functionality of HSE Integrated Health Areas and inform new Regional
Networks of Care for older people, ensuring resilient ecosystems that enhance
access and outcome equity for older people in peripheries.
