The Care Manager, future key player in our patient pathway

Published on 29 July 2021 Read 25 min

Year after year, the number of elderly people losing their autonomy in France will inevitably increase, due to the ageing of the population. Medical progress and improved living conditions will not be enough to curb this trend. France is expected to count around 25 million elderly people with a loss of autonomy by 2050. In order to offer quality care to these millions of seniors, the Care Manager, following the example of the Nordic countries, is emerging as the future key player in our healthcare system.

The Care Manager: a key player in the care pathway

In order to better anticipate the loss of autonomy of their population, Sweden, Denmark and Japan call on Care Managers, double-hatted – manager on the one hand, and health care staff on the other – and are now the cornerstones of their populations’ care pathways. Indeed, the Care Manager is at the centre of the triptych patient – medical staff – administrations, and fluidifies exchanges between these different entities. The Care Manager often has a background in physiotherapy, gerontology or geriatrics.

As a link in these healthcare systems, their role is twofold:

  • To measure the levels of dependence of the elderly before examining them regularly, if their condition does not allow them to be fully independent.
  • To ensure patients’ treatment compliance (i.e. that they take properly their medication), to assure their homes to be well equipped to enable them to independence, and to provide a smooth return to home after a stay in hospital for instance.

Read also: From hospital to home health care: how new technologies accelerate the ongoing transition

In addition, it replaces the informal caregiver (family member or friend), a player who is not well known, valued and yet indispensable. Although still absent in France, their inclusion in our healthcare system would be just as relevant as in the countries mentioned.

The Care Manager: an obvious role to play in prevention

Today, loss of autonomy and decline in motor skills detecting programmes are emerging, such as the WHO’s ICOPE (Integrated Care for the Elderly) programme, which has developed a tool for measuring these intrinsic abilities in a few minutes, or the Bien-Vieillir project run by the Nice University Hospital, whose objective is to invent the future model of well ageing based on three backbones: better anticipation, better prevention and better monitoring.

If these systems were more widely deployed, it would make it possible, for example, to reduce the rate of potentially avoidable hospitalisations. Indeed, it is estimated that 20% of hospitalisations of the over 65 in 2015 were avoidable. Knowing that a day of short-term hospitalisation at the AP-HP cost in average of 898€ in 2019 and that 80% of the costs are covered by the health insurance system. A better prevention would avoid this type of expensive stay in our health system. Similarly, the rate of avoidable re-hospitalisation at 30 days – RH 30, was 12% in 2015. Prevention is better than cure.

Is healthy life expectancy an indicator of the shortcomings of our health care system?

The implementation of a Care Manager network in France would allow seniors to age in better conditions and thus increase their healthy life expectancy. Dr Hiroshi Nakajima, the former director of the WHO, stated on this subject in 1997 that “without quality of life, increased longevity is of little interest”. Among OECD countries, France has one of the highest life expectancies at birth. However, when it comes to healthy life expectancy, France is not a good performer, as it is below the OECD average. At the age of 65 a woman can expect to live +23.2 years, but only +11.2 years without disability, while at 65 a man can expect to live +19.4 years but +10.1 years without disability. This significant disparity could be reduced by better anticipating the detection of these frailties thanks to the intervention of a Care Manager.

Read also: How does the prevention of age-associated loss of autonomy and old age dependency positively impact our society?

However, the loss of autonomy care supervision in France is complex; characterised by the number and variety of stakeholders, funders and types of structures. This complexity, reinforced by the absence of a single, easily identifiable entry point into the care support system, leads to numerous breakdowns in care. The establishment of Care Managers would make it possible to bridge the gap between the various health structures, where today there is no centralised actor coordinating the health, medico-social and ambulatory structures.

As the care pathway is not optimised today, a coordinating actor would enable to linearise this complex pathway. The Care Manager could therefore be involved in various aspects of the care pathway, becoming a key contact for seniors, but also a key player on whom the various stakeholders in the care pathway can rely on.

About the authors, 

Fanny, Consultant and Quentin, Project Manager in the Alcimed’s Healthcare team in Switzerland

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