CONTEXT

MECHANISM

OUTCOMES

RESOURCES

REASONING

Having neither ADL nor cognitive impairments

Care coordination provided by a coordination centre

The focus is on facilitation of the access to the care and support needed. “If any crisis situation appears I am, or my informal caregiver is, able to call for adequate help.”

Feeling capable to remain at home

Having only a low impairment in ADL (lowADLonly),

Care coordination provided by a coordination centre

In this situation also, the focus is on facilitation, especially through adequate utilisation of information by the frail older person and his informal caregiver

Uncertainty about feeling capable to remain at home or not

Having a high level of ADL impairment (highADLonly)

Social case management

Exacerbations and worsening of the situation are anticipated and prevented.

Not feeling capable to remain