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Home-based long term care: a proposal for the future

Luís Filipe Barreira, Vice-President, Ordem dos Enfermeiros (OE), Portugal

Currently in Portugal, the home-based long term care model doesn't meet the two main challenges of health systems – responding to the continuous care needs of an increasingly ageing population and improving sustainability of the health system.

The impact of home-based long-term care on the sustainability of the health system and quality of life for chronically ill patients significantly improves access to timely quality healthcare and reduces costs associated with the provision of care to chronically ill patients. This is the main core of nursing.

The long-term care delivery model should be centred on primary healthcare, which, due to its proximity, knowledge and community base, allows safer, humanised, sustainable and cost-effective care.

The implementation of this model adapted to the characteristics and needs of health, disease and demography, enhances the health services’ response and integrates a more inclusive and equitable approach. It reduces asymmetries in access to healthcare, including promotion and prevention, boosting levels of well-being and quality of life and contributing to the reduction of the negative impacts of public health crises through a strong and effective network of local care supporting informal caregivers.

It is essential to: reinforce the groups of health centres with qualified professionals (professional title of Specialist Nurse or with differentiated and advanced competences attributed by the OE); improve access, quality and efficiency of care; strengthen Community Care Units and Integrated Continued Care Teams in accordance with the OE's Standard for the Calculation of Safe Staffing in Nursing Care; provide health units with adequate clinical equipment and material; accelerate referral processes, extending care provision and integrating on-site nursing care, teleconsultations, telemonitoring, etc.

The implementation of this model requires strengthening the access, sharing and health information instruments that guarantee interoperability and multidisciplinary digital referral systems and the adoption of an adequate financing and incentives policy.