Association for Public Policy Analysis & Management

Integrated health and social care (IHSC) has been shown to be an effective means towards addressing health equity for vulnerable populations including older adults, because it reflects a strong social determinants of health approach to providing health and social care. Government policies, fiscal, healthcare and social care, play an influencing role, and can drive, sustain and hinder IHSC efforts. A multiple case study of three IHSC initiatives comprised of community-based collaborating healthcare and social services organizations serving older adults in Ontario, Alberta and Nova Scotia was undertaken to determine how provincial and federal policies and agendas have impacted integration efforts. Data was based on key informant interviews with representatives from a cross-section of healthcare and social care organizations in each of the cases and focus groups that represented a smaller subset of the interviewees. There was commonality in the three cases, despite differences in urban/rural landscape, government regimes and governance systems. In all three cases, the impact of provincial seniors strategies was critical in helping to initiate and maintain integration efforts on both the healthcare and social care sides. In addition, the influence of government austerity agendas including decreasing the rate of healthcare spending on integration efforts was present in the three IHSC initiatives. Other policies and strategies included privacy policies, and poverty reduction strategies. The case study findings show the convergence of different fiscal, healthcare and social care policies in impacting inter-sectoral services coordination, and suggest a whole-of-government approach to policymaking for older adult populations in Canada.