Background:
Demographic aging in Italy necessitates innovative and sustainable long-term care (LTC) models, particularly given limited resources and increasing care needs. This study explores the dynamics of co-production in LTC, focusing on both home and residential care across four Italian regions.

Approach:
This study employs a mixed-methods approach, including a literature review, database analysis, and normative comparison. Public spending on social and health services for LTC and the degree of economic co-participation required from citizens are compared across four regions: Emilia-Romagna, Tuscany, Abruzzo, and Molise. The research considers both personal and public involvement by examining the roles of families and caregivers in co-producing care, with a focus on the influence of sociocultural factors such as family structures and social capital. A radar chart analysis is used to represent key elements of LTC management, highlighting the balance between home-based and residential care and associating this information with the prevalence of self-sufficient and non-self-sufficient residents in those settings. Data from ISTAT and regional sources are analyzed to assess the impact of co-production on service access, utilization, and sustainability. The study also examines the role of policy decisions, such as co-payments for home-based and residential care, on families' care choices.

Results:
The analysis reveals variability in public spending and co-payments for LTC services across the four regions. Emilia-Romagna and Tuscany show higher public spending and greater investment in home services than Abruzzo and Molise. In contrast, Abruzzo and Molise show a greater investment in residential care despite a significant proportion of self-sufficient residents in these facilities. While co-payments influence family care choices, this relationship is complex and likely affected by factors such as the availability of residential beds, home care services, and waiting lists. The study also identifies a link between family structures, social capital, and the capacity for co-production; regions with stronger social networks and more diverse family structures, can tend to demonstrate greater effectiveness in co-producing LTC services.

Implications:
This study emphasizes the need for a balanced approach to LTC models, recognizing both the benefits and challenges of co-production with families. While co-production can enhance care personalization, family satisfaction, and resource efficiency, it also requires significant engagement from families and caregivers, potentially leading to burdens and “co-destruction of value” if not managed effectively. Policy decisions must consider regional disparities in social capital, family structures, and co-payment schemes to promote equitable access to LTC services and ensure the sustainability of co-production models. Future research should investigate the complex interplay between policy decisions, family dynamics, and co-production outcomes and develop strategies to support families and caregivers involved in co-production.

References:
1. Pavolini E. Long-term care social protection models in the EU. European Social Policy Network, Report. 2022.
2. Gori C, Luppi M. Cost-containment long-term care policies for older people across the OECD: A scoping review. Ageing & Soc. 2022;pp.1-24.
3. Cepiku D, Marsilio M, Sicilia M, Vainieri M. A comprehensive framework for the activation, management, and evaluation of co-production in the public sector. J Clean Prod. 2022;135056.

Background
Difficulties in verbal expression, apathy, and social withdrawal are common symptoms of dementia, posing challenges for caregivers. This project investigates whether art interventions can benefit individuals with dementia and explores effective implementation methods, highlighting the power of interdisciplinary collaboration between Arts and healthcare, showcasing the strength of the teamwork and unity.
Approach
This action research focuses on resource integration, establishing collaborative models, and forming an execution team to identify culturally suitable activities. This four-stage case study can inspire community engagement and cross-disciplinary initiatives.
1. Generating ideas and securing resources: Art-making activities that engage the units of body, emotion, and expression can promote health. The researcher obtained sponsorship from the National Culture and Arts Foundation.
2. Forming a transdisciplinary team: The researcher discussed the collaboration model and specific details with the institution's manager and established a transdisciplinary team of artists, art therapists, nurses, social workers, and caregivers. The team holds a monthly art workshop focused on self-awareness and self-care to facilitate each individual’s role in participating in elder art groups from diverse professional perspectives.
3. Initiating an art group for elders with dementia: Ten participants aged 65 to 80 with moderate to advanced dementia engaged in weekly 90-minute sessions over twelve weeks in a long-term care facility. Thematic activities included painting, collage-making, and hand-sculpture workshops focused on exploring nature, home, travel, and life issues. These activities were designed to enhance sensory perception, evoke deep emotions, and foster motivation and focus for creation. The process was recorded.
4. Sharing and promoting artwork: The created artworks were exhibited, and the process was documented in community art spaces and seminars for healthcare and art professionals.
Result
This action approach benefits elders, healthcare professionals, and artists. Based on interviews and observation records, family members and caregivers reported that elders showed increased vitality, emotional expression, and social skills, proving the project’s effectiveness and instilling hope and optimism in the audience. Caregivers felt empowered and experienced reduced burnout, while administrators noted higher job enthusiasm among interdisciplinary team members, all of whom remained for three years compared to those who left after two years. The project exhibition attracted around 5,000 visitors and sparked interest and feedback on dementia care, leading the community to propose art groups for individuals with dementia.
Implication
Participants and viewers recognized the advantages of integrating art into dementia care and showed a desire to get involved. Community art museums and healthcare institutions aim to incorporate this approach into their practices. Consequently, a follow-up program will be launched to empower healthcare and art professionals in developing art interventions tailored to the local culture for dementia care. However, further examination of the long-term effects of these interventions on cognitive functions and community well-being is necessary.

Key words: art intervention, dementia care, interdisciplinary collaboration

BACKGROUND
Sustainability of high-quality health care is a major challenge, due to financial and personal shortages and social support. This account also for elderly care, which faces problems that are aggravated by double ageing of this population. Therefore, urge exists for the development of innovative ways of thinking about and organizing care. This includes changes to domain-cross, community and network care, in which professional care, social welfare and citizens join forces. To realize future-proof arrangements and living which contribute to meaningful ageing for the elderly, elderly care organizations in the Netherlands initiated several testing grounds in the beginning of 2023. This study intended to explore initial network movements towards community building and to define general factors that influence the developments in these testing grounds.
APPROACH
Participative action research (PAR) was conducted in five testing grounds (districts/neighborhoods) concerning a housing and care concept on elderly people, with a high range in contextual factors and located in a variety of environment. PAR is suitable to realize a change in practice, due to its participatory nature of the actors, ie. the care providers, (future) elderly, citizens, welfare, housing cooperations and policy makers. In co-creation with all stakeholders, the first two steps of the Practice Development cycle were performed: determination of situation and focus. Each testing ground had one project leader related to an elderly care organizations and one researcher, who supported the action combined research. In the testing grounds, awareness on the upcoming problems on elderly housing and care was created and developments on community building were facilitated. Cross-analyses on generic factors was performed including all testing grounds and experts on community building, physical environment, cross-domain care and social business case. Factors were categorized on the five elements of the existing model on collaboration between organizations (Kaats & Opheij, 2012): ambition, interests, relationship, organization and process.
RESULTS
There was a large variety in involved/engaged partners, developments and actions over time within the five testing grounds. Cross-analyses revealed several generic factors in each of the five elements of the model on collaboration between organizations. Several factors concerned two or more elements. Among other things, findings were on a ownership of the ambition, transparency of the elderly care organization (the true story please), equal partnership, unframing of the organization, and early inclusion of all important stakeholders. Furthermore, one transcending factor was defined, concerning the attitude and opinion of professional care organizations towards community building. Lessons learned were formulated and evaluated in the testing grounds, which continue their work in practice.
IMPLICATIONS
This study revealed insight in several main issues on a network collaboration to create a solution-oriented movement for a complex problem such as sustainable elderly care. Although the elderly care organizations initiated the surroundings and facilitated the first steps, citizens and the community are an indispensable partner in the actual movement on community building and care solutions. Health workers should embrace this knowledge and actively implement the lessons learned, in order to better support collaboration networks including professional care, social welfare and citizens.

Introduction: According to the World Health Organization, in 2019, there were one billion people aged 60 years and older. This number is projected to rise to 2.1 billion by 2050. There is a growing acknowledgement that older adults prefer to age in place—a concept that has gained policy attention in many countries, including Canada. However, older adults living in the community often experience loneliness and other health consequences. Our existing service model, which is heavily focused on disease and lacks the involvement of service users, is not adequately prepared to address the diverse social and healthcare needs of older adults living in naturally occurring retirement communities (NORCs). NORC is an unplanned community with a large proportion of older adults. This paper aims to describe a NORC-based program, Oasis, and explore how it could serve as a model for integrated care for older adults living in NORCs. The Oasis model is based on the Oasis Senior Supportive Living program (www.oasis-aging-in-place.com) developed in 2011 with a group of older adults living in a Kingston, Ontario, apartment building to address the problem of social isolation and its associated health risks. Through Oasis, older adults identify needs and interests, and a coordinator helps implement programming that fosters social connection, physical activity, and health and well-being. Since 2018, the Oasis Program has been implemented in 18 NORCs across Canada.
Approach: Researchers from three Canadian universities in collaboration with older adults designed and implemented a longitudinal study to assess the influence of Oasis on social isolation and healthy aging. The research team adopted quasi-experimental, comparative multiple case study design using mixed methods. The research team is collecting both qualitative and quantitative data from older adults living in NORCs with and without Oasis. The team is also interviewing landlords who have hosted the Oasis in their building to understand their perspectives on the implementation process and the benefits that the Oasis program could bring to older adults and society.
Results: Findings to date indicate that the Oasis program enhances a perceived sense of community among older adults, engages them in meaningful activities, and enables increased physical activity. We have also learned from participants that Oasis has increased older adults' access to key services, such as dental care, hearing aids, vaccine clinics and other public health interventions, without going outside of their building. Additionally, our early data indicate that having Oasis in a building contributes to transforming the building's atmosphere and enhancing the building's reputation.
Implications: We perceive Oasis to be aligned with integrated care and has enormous potential to offer and bring services closer to older adults living in NORCs. All the outcomes we observed in our preliminary analysis are encouraging and keep older adults physically and mentally healthy. This, in turn, will reduce pressure on the healthcare system and long-term care homes, eventually saving taxpayers money that the government uses to support publicly funded programs. Service providers and researchers working with older adults may replicate the Oasis model in their context.