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Integrated delivery of long-term care: country assessment toolkit


Hector Pardo-Hernandez

World Health Organization, CH
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Long-term care encompasses a wide range of health and social services that are delivered in different settings. Long-term care is susceptible to fragmentation in service delivery: during needs assessments, accessing benefits, data collection and in the diversity of quality improvement efforts. The aim of this work was to develop a toolkit for guiding the design, development and reporting of country assessments on the integrated delivery of health and social services for long-term care.


This toolkit is based on the principles of systems thinking, people-centeredness and integrated care, life-course approach, healthy ageing, human rights and gender perspective. The underpinning conceptual framework is the European Framework for Action on Integrated Health Service Delivery. The toolkit benefited from the input of professionals in the field of long-term care and from existing resources for fostering the delivery of integrated care for older people. There were complementary scientific and grey literature searches on long-term care research and assessments in Europe. The toolkit was piloted in six country studies for validation and adaptation to fieldwork.


The toolkit is designed along four domains: individual and population needs, performance measures, long-term care service delivery and system enablers. The toolkit outlines a standard process for country assessment, consisting of:  i) initial desk research, ii) country visit preparation, iii) country visit completion, iv) analysis of data and evidence and v) reporting of findings. The toolkit includes a checklist of items that should be covered during the initial desk research, as well as measures and outcomes for each item and detailed “where-to-look” information. Country site visits consists of three activities: i) individual and group interviews, ii) site visits and iii) workshops and focus groups. Data analysis focuses on comparing the needs of the older people against the performance measures and the overall services delivery adopting, to the extent possible, a gender and human rights perspective. The toolkit was implemented in Croatia, Denmark, Germany, Portugal, Romania and Turkey.


The toolkit can serve as blueprint to identify challenges and facilitators in pursuing integrated delivery of long-term care. The toolkit is pragmatic and can be adapted depending on whether the country assessment is initiated by local governments, international agencies, academia or services providers.


Promoting the availability and quality of long-term care services that are integrated, people-centred and properly managed is a right step for ensuring healthy lives and wellbeing in the old age. The overall aim of this toolkit is contributing to this endeavour.

Lessons learned:

The country assessment results will be instrumental to inform evidence-based policy recommendations that will help countries optimise existing long-term care systems and to inform the development of emerging ones.


The Toolkit did not undergo a formal validation process. Nevertheless, general feedback from stakeholders involved in the development was positive. Feasibility and acceptability of the toolkit were adequate during the country assessments.

Suggestions for future research:

The toolkit could be further refined based on the results of future country assessments.


How to Cite: Pardo-Hernandez H. Integrated delivery of long-term care: country assessment toolkit. International Journal of Integrated Care. 2021;21(S1):64. DOI:
Published on 01 Sep 2021.


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