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Canada's population is aging and there are concerns that the welfare system may not support the increased demands on it. Integrated health and social care (IHSC) produces positive health and system outcomes but it needs to be better understood within a Canadian context. The purpose of this collective case study of three IHSC initiatives in Alberta, Ontario and Nova Scotia was to determine the factors that support successful services integration among different healthcare and social services organizations serving older adults within a Canadian context.

This study used the Cheng and Catallo (2020) IHSC conceptual framework (CF) to guide the research. Primary data were based on key informant interviews of representatives from organizations that comprised each case and focus groups. A cross-case analysis was undertaken to determine common themes.

The cross-case analysis revealed that the three cases shared common integration and external influence factors based on the Cheng and Catallo (2020) CF. Some new factors were identified.

The study revealed that the Canadian context was important in influencing integration in the three cases and that there is a unique Canadian aspect to IHSC. The study offers up practical insights for government leaders and service administrators to improve IHSC for older adults. The study also identifies how the Cheng and Catallo (2020) IHSC CF can be enhanced and points to research opportunities to test the framework.

Rural regions in Canada are aging faster than urban centers, but access to health and social care is limited. Integrated health and social care (IHSC) through collaboration across different health and social care organizations can support enhanced care for older adults living in rural regions. However, IHSC is not well understood within a rural Canadian context.

A case study of a Canadian IHSC initiative, Geriatric Assessment Program Collaboratory (GAPC), in northern Alberta was undertaken to understand how successful IHSC can occur in an urban/rural region. The study used key informant interviews and a focus group of representatives from the GAPC organizations.

Nine factors were identified that support GAPC: communications, information sharing, shared vision and goals, inter-organizational culture, diffused leadership, team-based approaches, dedicated resources, role clarity, champions and pre-existing relationships. Eight external influence factors were identified as influencing partnership including geography, strong sense of community, inter-sectoral work, public policy, governance authorities and structures, funding models, aging communities and operating within a not-for-profit (NFP) setting.

The study reveals insights into how IHSC can occur within a rural Canadian context. This study demonstrates that IHSC occurs at the local level and that primary care providers can drive IHSC successfully.

The Healthy at Home (H@H) is an older adult day program that is in Toronto in Ontario, Canada. This is an integrated health and social care (IHSC) program that seeks to address the social isolation and health needs of a highly vulnerable older adult population living in the north Toronto communities. These are Russian-speaking Jewish older adult immigrants. The case provides a detailed description of the factors that enabled a diverse group of health and social care organizations to integrate their respective services to address the health and social care needs of their clients using a culturally appropriate and trauma-informed lens.

A case description comprised of key informant interviews, and a focus group was undertaken of representatives from health and social care organizations serving clients in the north Toronto area.

This case description identified eleven integration factors that enabled organizations to provide integrated care using a culturally appropriate and trauma-informed lens, and they include developing an aligned vision and goals, communications, an inter-organization culture of inter-dependence, champions, pre-existing relationships, and champions. In addition, operating in the not-for-profit sector, sector differences, enabling public policies and a strong sense of community have influenced integration of services across the organizational partners to serve its high-risk client group.

This case description lends insights into how IHSC can be leveraged to provide culturally appropriate and trauma-informed care for highly vulnerable client/patient populations. A lesson learnt is that social care partners can engage in successful integration leadership in joint health and social care integration efforts.

A conceptual framework for collaboratively based integrated health and social care (IHSC) integration is proposed to aid in understanding how to accomplish IHSC.

This model is based on extant literature of successfully IHSC initiatives.

The model aims to identify enabling integration factors that support collaborative integration efforts between healthcare and social services organizations. These factors include shared goals and vision, culture, leadership, team-based care, information sharing and communications, performance measurement and accountability agreements, and dedicated resources and financing. It also identifies factors that act as external influencers that can support or hinder integration efforts among collaborating organizations. These factors are geographic setting, funding models, governance structures, and public policies. These factors are intended to ensure that a realist lens is applied when trying to understand and explain IHSC.

This model is intended to provide a framework to support research, policy and implementation efforts.

The purpose of this paper is to develop a case definition of integrated health and social services initiatives that serve older adults, and will provide characteristics to aid in the identification of such initiatives. The case definition is intended to ease the identification of integrated health and social care initiatives.

A limited search was undertaken of both scientific and gray literature that documented and/or examined integrated health and social services initiatives. In addition, literature on well-documented and generally accepted integrated healthcare and social services models that reflect collaborations from healthcare and social services organizations that support older adults was also used to develop the case definition.

The case definition is as follows: healthcare organizations from across the continuum of care working together with social services organizations, so that services are complementary and coordinated in a seamless and unified system, with care continuity for the patient/client in order to achieve desired health outcomes within a holistic perspective; the initiatives comprise at least one healthcare organization and one social care organization; and these initiatives possess 18 characteristics, grouped under 9 themes: patient care approach; program goals; measurement; service and care quality; accountability and responsibility; information sharing; culture; leadership; and staff and professional interaction.

A limitation of this study is that the characteristics are based on a limited literature search. The quality of some of the literature both gray and published was not definitive: information on how they undertook the literature search was not provided; exclusion and inclusion criteria were not included; and there was insufficient detail on the design of the studies included. Furthermore, the literature reviews are based on integrated initiatives that target both seniors and non-senior’s based services. The cross-section of initiatives studied is also different in scale and type, and these differences were not explored.

The case definition is a useful tool in aiding to further the understanding of integrated health and social care initiatives. The number of definitions that exist for integrated health and social care initiatives can make it confusing to clearly understand this field and topic. The characteristics identified can assist in providing greater clarity and understanding on health and social care integration.

This study provides greater coherence in the literature on health and social care integration. It aids in better framing the phenomenon of healthcare and social services integration, thereby enhancing understanding. Finally, the study provides a very useful and concrete list of identifying characteristics, to aid in identifying integrated health and social care initiatives that serve older adults.