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Policy Briefs

InCARE Policy Brief no.10

The InCARE project aimed to improve the knowledge base and pilot test how to develop long-term care systems, concentrating on community based and home-based LTC delivery. The InCARE pilot projects followed a participatory approach, developed through Theory of Change, to uncover ways in which these forms of long-term care delivery can be developed to satisfy the current and future demand of care in Europe in a sustainable and fair manner , bringing evidence from three cases in Austria, Spain, and North Macedonia. Through the Theory of Change framework applied in the project, each of these intervention domains has been carefully mapped on clearly defined long-term and short-term outcomes to achieve their target impact goals via specific activities which were undertaken during the project implementation. In doing so, the InCARE project and the findings from the evaluation and monitoring of its activities demonstrate many ways in which the imminent challenges highlighted in the European Care Strategy can be addressed.

InCARE Policy Brief no.10

InCARE Policy Brief no.9: Потенцијал за воведување социјални иновации во услугите на долготрајната нега во Северна Македонија. [The Potential for Social Innovation in Long-term Care in North Macedonia] InCARE

This report indicates the importance of innovations in the overall strategy of development of formal Long-term care in the country. Despite the enabling legal framework, ensuring sustainability and scaling-up of innovation can be challenging as it usually demands further legal adjustments and financing by the authorities.

Innovations are mostly project-based and scalability is often considered at a very late stage. However, it is important to engage relevant stakeholders already in the design phase. The InCARE Project Theory of Change national workshop represented a novel and coherent approach, in which stakeholders from social and healthcare sector were mobilised and a theory of change map was designed that can contribute to the development of national policies.

InCARE Policy Brief no.9

InCARE Policy Brief no.8: Potenzial für soziale Innovation in der Langzeitpflege [Potential for social innovation in long-term care]

The Policy Brief describes key features of the Austrian long-term care system including recent policy measures. It further presents findings from the InCARE SWOT analysis to highlight relevant topics for implementing social innovation in long-term care in Austria. Following the introduction of examples of social innovation in long-term care, the most important starting points for using the potential of social innovation in this context are discussed.

InCARE Policy Brief no.8

InCARE Policy Brief no.7: Policy brief on outcomes and impact, sustainability and potential for scale-up of the pilot in Spain.

To facilitate the continuity of social innovation projects, which are usually developed in a limited period under external funding, the following document describes the approach to sustainability and scalability of the Spanish InCARE pilot project developed in Gipuzkoa. The paper describes the work done on changing the role of psychologists in a support service for carers of people living with dementia in order to favour the coordination of services with social services of local councils and community resources.
The document describes the concept used to work on sustainability and scalability in the project, the key issues, barriers and potentials identified at local, regional and national level, the ecosystem of actors involved and their role in scalability, the different strategies used and the future steps after the end of the piloting period of the InCARE project. This document can be useful for those social innovation actors and different administrations looking to scale up a project, to facilitate possible developments of similar projects, and to plan for possible barriers and potentials that may arise in the process of setting up innovation projects.

InCARE Policy Brief no.7

InCARE Policy Brief no.5: Policy brief on outcomes, impact, sustainability and scale up of the Emergency button pilot in North Macedonia

he Red Cross of the Republic of North Macedonia (RCNM) implemented a pilot intervention focusing on an innovative community-based approach. The core element of the pilot intervention was the integration of an Emergency Button Service within its home care package as part of the broader InCARE EaSi call project. With the support of its policy partners, the Ministry of Labour and Social Policy, and the Ministry of Health, the Northern Macedonian pilot aimed to improve care for dependent elderly.

The InCARE project used the Theory of Change approach, which involves working closely with multiple stakeholders including care users to meticulously draft the project’s strategic direction, develop relevant interventions, and monitor and evaluate its progress. This approach is often implemented through a series of participatory workshops where stakeholders identify the intended impact, the required outcomes, necessary activities, critical assumptions and the ceiling of accountability which indicates the elements of the Theory of Change responsible for driving a certain aspect of impact.

InCARE Policy Brief no.5

InCARE Policy Brief no. 4: The Potential for social innovation in Spain (in Spanish)

The InCARE Project Theory of Change workshop on long-term care in Spain in the next decade represented an innovative, coherent and coordinated approach, in which multiple stakeholders participated A theory of change map was designed that can help the development of national policies, in line with recent policy developments in Spain in favour of a person-centered care model.

This report indicates the need to combine investment both in the design and development of social innovation and in scaling up innovative pilots and ensuring that these innovative approaches are sustainable. It calls for the creation of networks between communities, service providers, and legislators at the local, regional, and national levels.

InCARE Policy Brief no.4

InCARE Policy Brief no. 3:
Co-developing and contextualising long-term care innovations in Europe using Theory of Change- lessons from InCARE

Ensuring affordable and high-quality care to all those who need it, a goal enshrined in the European Pillar of Social Rights, remains a considerable challenge for all EU Member States and other European countries. In the aftermath of the devastating effects of the COVID-19 pandemic on long-term care systems, considerable reforms are being implemented or planned across the region – including the first European Care Strategy, with sustainability and appropriateness of care recognized as paramount concerns. At the same time, there is growing recognition of the need to deliver care in the community and to reimagine traditional care models through socially innovative approaches, grounded in local community strengths and reflecting their needs and preferences. As momentum for re-imagining long-term care systems continues to build, strategies to empower stakeholders and co-develop contextually relevant and scalable solutions are important to ensure sustainability, relevance, and fit of long-term care innovations. Theory of Change, a planning and evaluation approach which is increasingly used in planning health and long-term care provides a systematic and robust way to approach this.

We have successfully applied Theory of Change in InCARE. Our experience offers a proof of concept for the applicability and usefulness of this approach in long-term care service and policy development. In this Policy Brief, we describe the Theory of Change process in InCARE and focus on formulating transferable lessons and recommendations for expanding Theory of Change approaches in this field.

InCARE Policy Brief no.3

InCARE Policy Brief no. 2:
The time to care about care! Responding to changing attitudes, expectations and preferences on long-term care in Europe

Fifteen years after the Special Eurobarometer 283 on Health and long-term care in the European Union, the results of the cross-national InCARE survey bring to light significant changes in the attitudes, expectations and long-term care experiences of Europeans. As momentum for reform is building both at national and European level, we find the policy discourse has not kept up with dynamic preferences and attitudes towards care, especially among younger cohorts.

Overwhelming support for increasing the role of the State in long-term care organization, provision and financing and shifting the burden of care away from families and individuals, is improperly reflected in current policies. This leads to declining trust in care systems, as well as increased the reliance on informal carers at the detriment of their health and wellbeing

Since 2007, the ability of care systems to adequately address evolving care needs has declined: residential care is unaffordable for many, and the supply of community-based services is falling considerably behind a rising demand. Rural communities and poorer individuals bare the brunt of growing capacity gaps, while women are disproportionately affected by the burden of frequent, intensive and undesired informal caregiving spells.

A reorientation towards person-centered, participatory, equitable and accessible care models is urgently needed to rebuild declining public trust in the ability of care systems to respond to the preferences and expectations of individuals and communities.

InCARE Policy Brief no.2 

InCARE Policy Brief no. 1:
Promoting Social Innovation in long-term care: A common narrative for change across Europe

In support of policy-makers and organizational stakeholders that wish to engage directly in the implementation of social innovation initiatives in LTC, this Policy Brief summarises  the key lessons arising from a decade of European experiences – with a focus on doing rather than analysing social innovation. We argue that local innovators should shift focus away from ‘best practice’ initiatives and towards defining the ‘best fit for purpose’ initiatives. Furthermore, we highlight the need to match investment in social innovation design and development with investment in scale-up and sustainability of social innovation approaches, in order to increase societal impact.

We propose four key principles that can guide social innovators in long-term care:
Start with the end in mind – shape a common and inclusive vision for progress;
Invent the right solution – redesign the best ideas to best-fit local circumstances;
Bring all aboard – engage meaningfully with as many relevant local stakeholders as possible;
Think big from the very beginning – partner early on with regional and national stakeholders.

InCARE Policy Brief no.1 

InCARE Factsheet no.3 :
Attitudes, experiences and expectations on long-term care
in North Macedonia/ Ставови, искуства и очекувања за долгорочна нега во Северна Македонија

The factsheet provides an accessible summary of the key findings from the data collected by the InCARE survey in North Macedonia and across Europe. Our results indicate:

  • Availability and affordability remain major barriers in accessing formal care services, particularly for low income earners and rural-living individuals
  • Many feel obligated to provide care for their loved ones, despite negative impacts on their career and health, warranting increased financial protection and recognition of social rights for informal carers, as well as expanded formal care options
  • Strong preferences for formal care options and less responsibility for families demonstrate a need for expansion of community care services and an increased role of the state in providing and financing care

InCARE Factsheet North Macedonia (EN)

Документот со факти обезбедува преглед на клучните наоди од собраните податоци од истражувањето на InCARE во Северна Македонија и Европа. Нашите резултати укажуваат на следното:

  • Достапноста останува главна бариера во пристапот до услуги за формална нега, особено за лицата со ниски примања и за лицата кои живеат во руралните средини
  • Многумина се чуствуваат обврзани да обезбедат нега за своите најблиски, и покрај негативните влијанија врз нивната кариера и здравје, со што се нагласува потребата за зголемена финансиска заштита и признавање на социјалните права на неформалните негуватели, како и проширување на опциите за формална нега
  • Изразените преференции за формални опции за нега и помалата одговорност за семејствата покажуваат потреба за проширување на услугите за нега во заедницата и зголемена улога на државата во обезбедувањето и финансирањето на негата

InCARE Factsheet Северна Македонија (MK)

Policy Roadmaps

InCARE Factsheet no.2 :
Attitudes, experiences and expectations on long-term care
in Spain/ Actitudes, experiencias y expectativas en los cuidados de larga duración en España

The factsheet provides an accessible summary of the key findings from the data collected by the InCARE survey in Spain and across Europe. Our results indicate:

  • Limited availability and high costs are commonly cited as barriers in access to care in Spain, suggesting a need for increasing financial protection and improved planning of care delivery
  • Spanish respondents have very low trust that the long-term care system will be able to respond to their future care needs, especially regarding the capacity and accessibility of community-based care solutions
  • Attitudes and preferences for care arrangements are shifting away from the traditional familialistic grounding of the Spanish care system, and towards a stronger role of the State and of professional services in long-term care provision

InCARE Factsheet Spain (EN)      

El factsheet ofrece un resumen accesible de las principales hallazgos de los datos recogidos por la encuesta InCARE en España y Europa. Nuestros resultados indican:

  • La limitada disponibilidad y los elevados costes suelen citarse como obstáculos para el acceso a los cuidados en España, lo que sugiere la necesidad de aumentar la protección financiera y mejorar la planificación de la prestación de cuidados
  • Los encuestados españoles tienen muy poca confianza en que el sistema de cuidados de larga duración sea capaz de responder a sus futuras necesidades, especialmente en cuanto a la capacidad y accesibilidad de las modalidades de atención comunitaria
  • Las actitudes y preferencias en cuanto a los cuidados se alejan del tradicional modelo familiar del sistema de cuidados español y se inclinan por un mayor papel del Estado y de los servicios profesionales en la prestación de cuidados de larga duración.

InCARE Factsheet España (ES) 

InCARE Factsheet no.1 :
Attitudes, experiences and expectations on long-term care
in Austria / Erfahrungen, Einstellungen und Erwartungen zur Langzeitpflege
in Österreich

The factsheet provides an accessible summary of the key findings from the data collected by the InCARE survey in Austria and across Europe. Our results indicate:

  • Informal caregiving and a perceived responsibility of families to provide care remain very common, despite strong preferences for an increased role of the state in care provision and financing;
  • Many Austrians (especially middle aged) have low trust that the care system will be able to respond to their preferences for future care, as limited availability and high costs are identified as key barriers in access;
  • Gender, age, socio-economic and rural/urban gaps in expectations, experiences and barriers to care highlight the need to increase social protection and address persistent inequalities.

InCARE Factsheet Austria (EN)      

Das Factsheet bietet eine verständliche Zusammenfassung der wichtigsten Ergebnisse der InCARE-Umfrage in Österreich und ganz Europa. Unsere Ergebnisse zeigen:

  • Informelle Pflege und die Auffassung, dass die Familie für die Pflege verantwortlich ist, sind nach wie vor weit verbreitet, obwohl eine stärkere Rolle des Staates bei der Bereitstellung und Finanzierung der Pflege befürwortet wird;
  • Wenige ÖsterreicherInnen (vor allem im mittleren Alter) vertrauen darauf, dass das System der Langzeitpflege ihre Wünsche und Erwartungen in Bezug auf ihren künftigen Betreuungs- und Pflegebedarf zu erfüllen vermag, wobei mangelnde Verfügbarkeit und hohe Kosten als Haupthindernisse für den Zugang zu Diensten und Einrichtungen genannt werden;
  • Trotz geschlechtsspezifischer, altersbedingter und sozio-ökonomischer Unterschiede sowie einem Stadt-Land-Gefälle bei Erwartungen, Erfahrungen und Zugangshindernissen wird deutlich, dass solidarische Systeme der sozialen Sicherung bei Pflege- und Betreuungsbedarf ausgebaut und anhaltende Ungleichheiten beseitigt werden müssen.

InCARE Factsheet Österreich (DE) 

Short Reports

InCARE Short Report: Design, Implementation and outcomes of the pilot in Spain

This new report presents the methodology  and the activities organised in the framework of the InCARE Pilot in Spain., and their qualitative and quantitative evaluation.

Furthermore, key messages are suggested and discussed in detail.

InCARE Short Report

InCARE Short Report: Design, Implementation and sustainability of the pilot in North Macedonia

This new report presents the methodology implemented and describes all the activities organised in the framework of the InCARE Pilot in North Macedonia.

The Emergency button pilot was a successful attempt of providing a long-term care service example in in North Macedonia. Although its design and implementation phases faced various obstacles due to the Covid19 situation, technical difficulties and sustainability concerns, it has raised the bar of long-term care provision in the country. Actions need to be carried out in the future in order to establish the service and secure its potential expansion in the long run.

InCARE Short Report

InCARE Short Report: Design, Implementation and sustainability of the the pilot in Austria

Within the context of the existing LTC system, the Austrian case pilot intervention was designed to address the challenges faced by LTC services. In line with the overall framework of the InCARE project, the Austrian pilot intervention has been preceded by a Theory of Change (ToC) workshop in order to determine the broader impact that the intervention should achieve as well as the various outcomes and activities that need to be taken to reach this ultimate goal in a participative format with the stakeholders and the relevant actors.

This new report presents the methodology implemented and describes all the activities organised in the framework of the InCARE Pilot in Austria, including training modules for carers, contribution to better accessibility and adequacy of services provided locally, networking, co-operation and knowledge transfer. The publication also sheds light on the lasting impact of the intervention.

InCARE Short Report

InCARE Short Report :
Social Innovation in LTC in Europe: Towards a common narrative for change

Long-term care systems throughout Europe are facing the challenge of ensuring affordable and high-quality care to diverse ageing populations, while responding to the societal effects of the Covid-19 pandemic. As sustainability is of paramount concern, interest in socially innovative approaches that build on local community strengths has been steadily rising. In this short report, we step back, take stock and synthesize the key insights that can be derived from the decades long journey of promoting social innovation in Europe, with a view to supporting policy-makers and organizational stakeholders that wish to engage directly in the implementation of social innovation initiatives in long-term care.

InCARE Short Report no.1

Short Report : Long-Term Care landscape in Austria

This report presents information on the long-term care (LTC) landscape in Austria. It builds on two activities in the InCARE project: the situational analysis and the SWOT-Analysis. The SWOT analysis identified Strengths, Weaknesses, Opportunities and Threats of the LTC-system in Austria.

Short Report: Long-Term Care landscape in Austria (EN)

Short Report : Long-Term Care landscape in North Macedonia

This new report gives an overview of the LTC landscape in North Macedonia, focusing on the country context, support capacity and care needs in the community as well as service delivery.

Short Report: Long-Term Care landscape in North Macedonia (EN)(EN)

Short Report :
Long-Term Care landscape in Spain

Imserso and Matia Foundation, advised by Vilans and the European Centre for Social Welfare Policy and Research, carried out a situational analysis of long-term care in Spain, presented in a short report. This publication includes an overview of the needs and capacity for community-care provision, combining demographic, socioeconomic, and health and welfare policy approaches. It looks into the services provided by the health and social care system, their financing, and the quality of the care provided. It also describes the political context, the distribution of competences, and the progress of new technologies within the health and care sector. Bibliographical references and a SWOT analysis* support the document.

* A SWOT analysis is a strategic planning technique to help an organization identify Strengths, Weaknesses, Opportunities, and Threats.

Short Report: Long-Term Care landscape in Spain (EN)

InCARE Policy Roadmap for North Macedonia

The Policy Roadmap North Macedonia presents the InCARE projection of future costs of LTC as well as recommendations for the development of the LTC system.

InCARE Policy Roadmap for North Macedonia

InCARE Policy Roadmap for Spain

New report: The InCARE Policy Roadmap for Spain describes recommendations for developing the Spanish LTC system.

InCARE Policy Roadmap for Spain

InCARE Policy Roadmap for Austria

The Austrian InCARE Policy Roadmap presents recommendations for the further development of long-term care in the country. The recommendations focus on three different areas: developing the public debate on long-term care further, developing and expanding of services and addressing future needs in terms of financing long-term care.

These recommendations build on the different InCARE activities. The recommendations relating to financing long-term care were developed based on a cell-based model to calculate the projected costs of long-term care in Austria in 2035. It includes five different scenarios addressing care needs, availability of informal care, availability of residential care spots, availability of live-in care and wage costs. The calculation is also described in detail in the technical annex of the policy roadmap.

InCARE Policy Roadmap for Austria

InCARE contribution to call for evidence on European Care Strategy

The InCARE project brings together a multi-disciplinary group of 10 project partners across 6 European countries, representing care service providers, public authorities, research and academic institutions and NGOs. Eighteen months into our joint work, we wish to contribute to the on-going call for evidence a summary of results and learnings derived from a rapid evidence review on social innovation in long-term care, an online survey on attitudes, experiences, expectations on long-term care and multi-stakeholder Theory of Change processes in 3 countries.

We argue that long-term care policy in Europe should focus on:

  • Promoting an inclusive, person-centered, rights-based and value-driven vision for long-term care systems and service development
  • Promoting participatory approaches to decision-making and empower local actors
  • Investing in community-based care solutions
  • Investing in the development of data infrastructure in long-term care
  • Matching investment in design and development of innovative long-term care services with investment in scale-up and sustainability of innovative approaches
  • Agreeing to ambitious targets at EU and national level, develop national long-term care strategies and increase financial support for the development of accessible, affordable and high-quality community-based long-term care services.

InCARE contribution EU Care Strategy (EN)      

Evaluation Report

InCARE Project Evaluation Report

New report: The InCARE project evaluation report presents the application of the ToC framework in the pilot interventions in the three case countries, Austria, North Macedonia, and Spain, as well as the whole project.

InCARE Evaluation Report


InCARE Research Tool 2: SWOT analysis guide.

This document is intended to be used as part of the situational analysis of the long-term care ecosystems in the three countries participating in the InCARE project (Spain, Austria and North Macedonia), in conjunction with the Situational analysis topic guide (InCARE Research tool 1). The SWOT analysis should begin after the completion of the desk review (see Topic guide) and focuses on the analytical interpretation of the collected information.

InCARE SWOT analysis guide

InCARE Research Tool 1:  Situational analysis topic guide

This document provides the topic guide for carrying out a situational analysis of the long-term care ecosystems in the three countries participating in the InCARE project (Spain, Austria and North Macedonia). The situational analysis provides a comprehensive overview of long-term care system performance, collating data on sustainability, efficiency, accessibility, equity and quality of care for older people with cognitive and functional impairment. It also includes an in-depth analysis of demand for care, grounded in a detailed understanding of the demographic and epidemiological situation in each country.

The topic guide is designed to cover information and dynamics both at national level and at the regional level relevant for pilot implementation.

InCARE Situational analysis topic guide

InCARE Dissemination Plan

This plan is a practical document that describes the dissemination activities undertaken by all InCARE partners to contribute to the achievement of the project’s overall objectives. It sets out in detail the objectives of the communication (why), then discusses the target groups (to whom), the key messages (what) and the tools to be used (how). It explains how Eurocarers is going to disseminate information about the project at European and global levels, while inviting partners to elaborate national-level dissemination plans for each pilot country, providing guidance to that end. The Dissemination Plan also envisages how to monitor the dissemination activities carried out by the partners, in order to assess the implementation of the plan on a constant basis.

InCARE Dissemination Plan V1

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