Action Research Investigating the potential in adhering to the development and design of a new model for LTC based on innovative financing, in the context of countries facing budget cuts in social care.

Background Ageing, replacement and dependency ratios in countries facing budget cuts in social care, constitute a threat as according to the OECD, in 2030 aged population will grow from 18% today to 25% in average. Their healthcare systems suffer from severe budgetary cuts with cuts in social care reaching almost 80% in the recession period. The need for policy coordination, scaling innovative solutions adapted to a regional context, is imminent while reducing budgetary costs for LTC. This is an innovative funding model from RoI of health related resources for social care at community scale, integrating care bundle, managed by local PPP with municipal services, including prevention, health at home and rehabilitation as opposed to in-hospital episode-based care. The targeted population is elderly population with disability. Methodology and Results •           Study of Municipalities' Thermal Springs in South East Europe, as investment assets . •           Five Greek municipalities were shortlisted according to their assets, resources and maturity to adhere to the model. •           Analysis on the local health resources, Evaluation of the Health Tourism potential, RoI estimation, projection covering population health of 30.000, 65+ people. •           Case studies preparation for the Municipalities, with Business and Investment Plans - deliberation. •           Action research tools: participant observation recordings, questionnaire surveys, structured and unstructured interviews, and case studies. Qualitative and quantitative data collection and content analysis from structured and unstructured interview •           Traditional Action research method finalization. •           One municipality adhered and signed an EoI in 2018. The scope of the study was to observe municipalities in their decision making process and change management, adopting innovative models of LTC. The pilot area was the Municipality of Trikala - the Mayor of Trikala signed an EoI for the proof of concept stage. Discussion Difficulty of local staff and mayors to grasp the potential of innovation, due to lack of investment experience, asset management, integrated care and reinvested RoI, managed by a Civil Non Profit PPP company. Difficulty of the tourism and health municipal administrations to work together on asset based income generation for public health needs. Neither department demonstrated knowledge how to exploit municipal assets for common policy in LTC, investments. Mayors with lesser experience in innovation management expressed fear for collateral and preferred inertia over complications. Transferability is guaranteed by the proven model's balanced assets to needs of LTC,  as well as Sustainability, by the PPP form of the management company, assuring consensus at community level. Conclusions The innovative character of the model was its main limitation. The modernization gap in policies and social care models was the reason that kept back some municipalities from expressing interest. The municipality of Trikala is one of the 20 most innovative cities in Europe, awarded by the European Commission DG Connect. The mayor is an innovative policy decision maker. He foresaw the needs to adopt innovation, along with the necessary technical, administrative and institutional reforms, in adhering to the model. Working with pioneers, intense awareness and consensus towards cooperation in implementation prove to be key factors.


Background
Ageing, replacement and dependency ratios in countries facing budget cuts in social care, constitute a threat as according to the OECD, in 2030 aged population will grow from 18% today to 25% in average. Their healthcare systems suffer from severe budgetary cuts with cuts in social care reaching almost 80% in the recession period. The need for policy coordination, scaling innovative solutions adapted to a regional context, is imminent while reducing budgetary costs for LTC. This is an innovative funding model from RoI of health related resources for social care at community scale, integrating care bundle, managed by local PPP with municipal services, including prevention, health at home and rehabilitation as opposed to in-hospital episodebased care. The targeted population is elderly population with disability.

•
Study of Municipalities' Thermal Springs in South East Europe, as investment assets .
• Five Greek municipalities were shortlisted according to their assets, resources and maturity to adhere to the model.

•
Analysis on the local health resources, Evaluation of the Health Tourism potential, RoI estimation, projection covering population health of 30.000, 65+ people.

•
Case studies preparation for the Municipalities, with Business and Investment Plans -deliberation.
• Action research tools: participant observation recordings, questionnaire surveys, structured and unstructured interviews, and case studies. Qualitative and quantitative data collection and content analysis from structured and unstructured interview • Traditional Action research method finalization.

•
One municipality adhered and signed an EoI in 2018.
The scope of the study was to observe municipalities in their decision making process and change management, adopting innovative models of LTC. The pilot area was the Municipality of Trikala -the Mayor of Trikala signed an EoI for the proof of concept stage. Discussion Difficulty of local staff and mayors to grasp the potential of innovation, due to lack of investment experience, asset management, integrated care and reinvested RoI, managed by a Civil Non Profit PPP company. Difficulty of the tourism and health municipal administrations to work together on asset based income generation for public health needs. Neither department demonstrated knowledge how to exploit municipal assets for common policy in LTC, investments. Mayors with lesser experience in innovation management expressed fear for collateral and preferred inertia over complications. Transferability is guaranteed by the proven model's balanced assets to needs of LTC, as well as Sustainability, by the PPP form of the management company, assuring consensus at community level.

Conclusions
The innovative character of the model was its main limitation. The modernization gap in policies and social care models was the reason that kept back some municipalities from expressing interest. The municipality of Trikala is one of the 20 most innovative cities in Europe, awarded by the European Commission DG Connect. The mayor is an innovative policy decision maker. He foresaw the needs to adopt innovation, along with the necessary technical, administrative and institutional reforms, in adhering to the model. Working with pioneers, intense awareness and consensus towards cooperation in implementation prove to be key factors.