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Improving the mix of institutional and community care for older people with dementia : an application of the balance of care approach in eight European countries

  • S. Tucker
  • C. Sutcliffe
  • I. Bowns
  • D. Challis
  • K. Saks
  • H. Verbeek
  • E. Cabrera
  • S. Karlsson
  • H. Leino-Kilpi
  • G. Meyer
  • M. E. Soto
  • Astrid Stephan
  • Anna Renom-Guiteras
  • Dirk Sauerland
  • Ansgar Wüubker
  • Patrick Bremer
  • Jan P H Hamers
  • Basema Afram
  • Hanneke C. Beerens
  • Michel H C Bleijlevens
  • Sandra M G Zwakhalen
  • Dirk Ruwaard
  • Ton Ambergen
  • Ingalill Rahm Hallberg
  • Ulla Melin Emilsson
  • Connie Lethin
  • David Jolley
  • Brenda Roe
  • Alistair Burns
  • Jaana Koskenniemi
  • Riitta Suhonen
  • Matti Viitanen
  • Seija Arve
  • Minna Stolt
  • Maija Hupli
  • Ene Margit Tiit
  • Jelena Leibur
  • Katrin Raamat
  • Angelika Armolik
  • Teija Tuula Marjatta Toivari
  • Adelaida Zabalegui
  • Ester Risco
  • Carme Alvira
  • Marta Farre
  • Susana Miguel
  • Agathe Milhet
  • Sandrine Sourdet
  • Sophie Gillette
  • Bruno Vellas
Publiceringsår: 2016-12-01
Språk: Engelska
Sidor: 1327-1338
Publikation/Tidskrift/Serie: Aging and Mental Health
Volym: 20
Nummer: 12
Dokumenttyp: Artikel i tidskrift
Förlag: Carfax Publishing

Abstract english

Objectives: To examine whether the mix of community and institutional long-term care (ILTC) for people with dementia (PwD) in Europe could be improved; assess the economic consequences of providing alternative services for particular groups of ILTC entrants and explore the transnational application of the ‘Balance of Care’ (BoC) approach. Method: A BoC study was undertaken in Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden, and the UK as part of the RightTimePlaceCare project. Drawing on information about 2014 PwD on the margins of ILTC admission, this strategic planning framework identified people whose needs could be met in more than one setting, and compared the relative costs of the possible alternatives. Results: The findings suggest a noteworthy minority of ILTC entrants could be more appropriately supported in the community if enhanced services were available. This would not necessarily require innovative services, but more standard care (including personal and day care), assuming quality was ensured. Potential cost savings were identified in all countries, but community care was not always cheaper than ILTC and the ability to release resources varied between nations. Conclusions: This is believed to be the first transnational application of the BoC approach, and demonstrates its potential to provide a consistent approach to planning across different health and social care systems. Better comparative information is needed on the number of ILTC entrants with dementia, unit costs and outcomes. Nevertheless, the findings offer important evidence on the appropriateness of current provision, and the opportunity to learn from different countries' experience.


  • Geriatrics
  • Health Care Service and Management, Health Policy and Services and Health Economy
  • balance of care
  • dementia
  • home care
  • institutionalisation
  • resource allocation


  • Older people's health and Person-Centred care
  • ISSN: 1360-7863
Ulla Melin Emilsson
E-post: ulla [dot] melin_emilsson [at] soch [dot] lu [dot] se



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+46 46 222 94 16



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