Institutional coordination during the COVID-19 pandemic: the case of the nursing homes in Spain

Abstract

The pandemic has posed a major challenge to federations and multilevel systems, due to the high degree of institutional coordination required to combat the virus. In the specific area of long-term care, the fragmentation between health and social services in many countries has made it difficult to respond to the threat posed to institutionalized older people.

This article analyzes the response of Spain, a largely decentralized state, to the COVID-19 crisis in nursing homes during 2020, with a focus on institutional coordination mechanisms (intergovernmental and intersectoral). We aim to provide evidence on the drivers of and barriers to effective institutional management of the health crisis.

Semi-structured interviews with key informants (n=30) and a desk study were conducted. The main results suggest negative effects of the incomplete knowledge among health policy makers about the nursing home sector, the insufficient degree of coordination between health and social services departments in some subnational regions during the first weeks of the pandemic, the scarce number of intergovernmental coordination meetings in the social services department, the lack of preparedness, and data and information shortcomings. On the other hand, we observe a positive impact of the creation of formal ex novo mechanisms (commissions, committees) and the use of informal mechanisms (such as groups on social messaging platforms) for the exchange of information and political decision making. We conclude that there is a need for greater integration of objectives and strategies between the departments of health and social services in the socio-sanitary field both at national and subnational levels.