LTCcovid Country Profiles

Responses to 4.04. Reforms to improve care coordination

The LTCcovid International Living report is a “wiki-style” report addressing 68 questions on characteristics of Long-Term Care (LTC) systems, impacts of COVID-19 on LTC, measures adopted to mitigate these impacts and new reforms countries are adopting to address structural problems in LTC systems and to improved preparedness for future events. It was compiled and updated voluntarily by experts on LTC all over the world. Members of the Social Care COVID-19 Resilience and Recovery project moderated the entries and edited as needed. It was updated regularly until the end of 2022.

The report can be read by question/topic (below) or by country: COVID-19 and Long-Term Care country profiles.

To cite this report (please note the date in which it was consulted as the contents changes over time):

Comas-Herrera A, Marczak J, Byrd W, Lorenz-Dant K, Patel D, Pharoah D (eds.) and LTCcovid contributors.  (2022) LTCcovid International living report on COVID-19 and Long-Term Care. LTCcovid, Care Policy & Evaluation Centre, London School of Economics and Political Science.

Copyright is with the LTCCovid and Care Policy and Evaluation Centre, LSE.



A number of reforms in EU Member States have been introduced or are planned (2021) focusing on integrated delivery of care and to set up coordination structures (source: EU report).

International reports and sources

EU report on LTC (2021) highlights recent reforms related to care coordination in Member States.

Some information regarding reforms in Canada related to, among other things, care coordination could be found online.

An EU report shows that in 2017 the federated region of Flanders was divided into ‘primary care zones’ to improve the governance of homecare services. These zones are responsible for coordinating the different primary and social care partners within the zone, and are central mechanism for coordinating homecare among different stakeholders. Moreover, a federal programme has been implemented to improve care for people with chronic diseases, including older people. Since 2018, 12 projects have been set up at local level, testing a series of measures to improve care integration.

During the crisis, setting up a strong collaboration model and integrated care between nursing homes and hospitals has enabled nursing homes to manage specific and complex care in their own environment. A published report shows that integrated care is possible and that both the hospital and the nursing homes benefit from such a system. They suggested that investments in people, resources, training and guidance concerning transitional care, and knowledge exchange between hospitals and nursing homes, are necessary to guarantee a more efficient and robust approach to (pandemic) crises in nursing homes.


Deschacht, M., Malfait, S., & Eeckloo, K. (2021, May 1). Integrated care for older adults during the COVID-19 pandemic in Belgium: Lessons learned the hard way. International Journal of Older People Nursing. John Wiley and Sons Inc.

Last updated: March 3rd, 2022   Contributors: William Byrd  |  

An EU report noted that in 2021 Estonia is planning an overarching reform of the LTC system, establishing an integrated LTC framework to ensure the cross-sectoral supply, availability, and quality of services.

Last updated: November 23rd, 2021

An EU report notes that a proposal for a comprehensive reform is underway (2021), focusing on long-term and palliative care. The main aim is to strengthen the integration of social care and healthcare.

Last updated: November 23rd, 2021

An EU report noted that a draft long-term care act (2021) aims to facilitate and ensure the implementation of long-term care as the new pillar of social security which will take the form of integrated activities.

Last updated: September 7th, 2021

An EU report (2021) noted that a new model for high-quality integrated social services was established in 2020. The reform is aimed at establishing an integrated network of homecare services for people with disabilities and older people.

Last updated: November 24th, 2021

As of March 2021, Canada has announced a number of LTC reforms, including reforms intended at improving coordination of LTC services across the health system, and particularly integration at the level of local community services (source: Long-Term Care Services – HSO Health Standards Organization). 

Last updated: February 11th, 2022

An EU report (2021) notes that care-support bases offering advice and support are being set up in Germany, providing relevant information, application forms, and practical assistance (European Commission, 2021).


European Commission (2021) 2021 Long-term care report – Trends, challenges and opportunities in an ageing society. Country profiles Vol. 2. Available at: Publications catalogue – Employment, Social Affairs & Inclusion – European Commission ( (Accessed 4 February 2022).

Last updated: February 12th, 2022   Contributors: Klara Lorenz-Dant  |  Thomas Fischer  |  Kerstin Hämel  |  

An EU report notes that a programme to establish 150 integrated care centres for older people was implemented in 2018.  The centres provide information and support to homecare services provided exclusively to older people, and co-ordinate the existing care services such as the open protection centres for older people, daycare centres, and the ‘help at home’ programme.

Last updated: November 24th, 2021

An EU report noted that several programmes were set up in 2017 with an aim to improve integrated delivery of care and the matching of care to needs.

Last updated: November 24th, 2021

The Health and Care Bill contains provisions to enable integrated health care systems to play a greater role. There are two forms of integration underpinned by the legislation: integration within the NHS and greater collaboration between the NHS and local government. Measures will also be brought forward for statutory integrated care systems (ICSs). These will be comprised of an ICS Health and Care Partnership, bringing together the NHS, local government and partners, and an ICS NHS Body. The ICS NHS body will be responsible for the day to day running of the ICS, while the ICS Health and Care Partnership will bring together systems to support integration and develop a plan to address the health, public health, and social care needs of the system (DHSC, 2021; 2022).

In parallel with the Health and Social Care Bill, the government is also developing an integration white paper, which is seeking to establish greater integration between health and social care services. The contents of the white paper are unclear at present but media reports in the trade press suggest that the proposals will seek to facilitate integration through the pooling of budgets and establishing a single line of accountability. The plans have raised concerns amongst experts. The exact date of publication is unknown, but it is expected in late 2021/early 2022 (Edwards, 2021).

The government plan for social care, Build Back Better (DHSC, 2022), contains provisions for improving the integration of health and social care. This will be shaped by three principles:

  1. Outcomes focussed – The government will work with systems to identify a single set of system-based health and care outcomes that local systems (including ICSs and Local Authorities) will be asked to deliver.
  2. Empowering local leaders – Local leaders will be given the freedom to align incentives and structures in order to deliver these outcomes in the way that is best for their communities.
  3. Wider system reforms – There will be Care Quality Commission (CQC) oversight of commissioning of adult social care by Local Authorities, which will be introduced through the Health and Care Bill, and a role for the CQC in assessing the overall quality of ICSs.

DHSC (2021). Integration and innovation: working together to improve health and social care for all. Department of Health and Social Care Policy Paper. Retrieved from: Accessed on 28/03/2022

DHSC. (2022). Build Back Better: Our Plan for Health and Social Care. Department of Health and Social Care Policy Paper. Retrieved from: Accessed on 28/03/2022

Edwards, N. (2021). Pooling NHS and social care budgets needs more thought. HSJ. Retrieved from: Health Service Journal. Accessed on 28/03/2022

Last updated: March 28th, 2022   Contributors: William Byrd  |  Natasha Curry  |  

Contributors to the LTCcovid Living International Report, so far:

Elisa Aguzzoli, Liat Ayalon, David Bell, Shuli Brammli-Greenberg, Erica BreuerJorge Browne Salas, Jenni Burton, William Byrd, Sara CharlesworthAdelina Comas-Herrera, Natasha Curry, Gemma Drou, Stefanie Ettelt, Maria-Aurora Fenech, Thomas Fischer, Nerina Girasol, Chris Hatton, Kerstin HämelNina Hemmings, David Henderson, Kathryn Hinsliff-Smith, Iva Holmerova, Stefania Ilinca, Hongsoo Kim, Margrieta Langins, Shoshana Lauter, Kai Leichsenring, Elizabeth Lemmon, Klara Lorenz-Dant, Lee-Fay Low, Joanna Marczak, Elisabetta Notarnicola, Cian O’DonovanCamille Oung, Disha Patel, Martina Paulikova, Eleonora Perobelli, Daisy Pharoah, Stacey Rand, Tine Rostgaard, Olafur H. Samuelsson, Maximilien Salcher-Konrad, Benjamin Schlaepfer, Cheng Shi, Cassandra Simmons, Andrea E. SchmidtAgnieszka Sowa-Kofta, Wendy Taylor, Thordis Hulda Tomasdottir, Sharona Tsadok-Rosenbluth, Sara Ulla Diez, Lisa van Tol, Patrick Alexander Wachholz, Jae Yoon Yi, Jessica J. Yu

This report has built on previous LTCcovid country reports and is supported by the Social Care COVID-19 Resilience and Recovery project, which is funded by the National Institute for Health Research (NIHR) Policy Research Programme (NIHR202333) and by the International Long-Term Care Policy Network and the Care Policy and Evaluation Centre at the London School of Economics and Political Science. The views expressed in this publication are those of the author(s) and not necessarily those of the funders.