What we know
Care coordination ensures that an identified health professional can convey information between the multidisciplinary team and the person, but also to ensure the person and their family are able to effectively participate in forward planning.
Continuity, coordination and transition of care are key domains for providing quality care to older adults at the end of life. Continuity refers to the exchange of knowledge between carers, the person and health professionals while care coordination is the alignment of care across providers and settings. Continuity of care and care coordination have significant impact on satisfaction and quality of life as well as reducing the number of acute care re-admissions. Both require that people and services have the capacity to adequately forward planning.