# Organizational and financial challenges in care transitions: a qualitative study of long-term care systems in Germany, the Netherlands and Poland

## TL;DR

This study explores how organizational and financial issues affect care transitions for older adults in long-term care systems in Germany, the Netherlands, and Poland.

## Contribution

The study highlights the role of regulatory aspects and protocols in shaping care transitions, which have been under-researched.

## Key findings

- Care transitions for older adults in long-term care systems in Germany, the Netherlands, and Poland are suboptimal.
- Organizational challenges like communication and coordination significantly impact care transitions.
- Reimbursement is a key financial factor influencing care transitions in the three countries.

## Abstract

Suboptimal care transitions are common and have been linked to adverse events, hospital readmissions, low satisfaction with care, and high healthcare costs. Broader organizational and financial aspects are known to affect care transitions in long-term care systems. The objective of this study was to gain insights into the organizational and financial challenges affecting care transitions in long-term care systems in Germany, the Netherlands and Poland, and to inform potential system adaptations for improving care transitions in those countries.

We employed an exploratory qualitative research design. In total, 22 semi-structured interviews involving 23 participants were conducted with providers representing primary care, hospitals, long-term care, and insurers/payers. Data were analyzed using qualitative content analysis with the use of programme ATLAS.ti. A deductive-inductive approach was applied to code the interviews.

Care transitions of older adults in long-term care systems in Germany, the Netherlands and Poland are suboptimal. Organizational challenges - such as communication, transfer of information, and coordination of resources have an immense impact on care transitions and require urgent attention. Among financial challenges, reimbursement plays a particularly crucial role in shaping care transitions across the three countries. Additionally, legal regulations, policies, the availability of protocols, and agreements between the providers might either facilitate or hinder care transitions.

Our study adds to existing frameworks in this area by highlighting the importance of regulatory aspects and the availability of protocols for optimizing care transitions. These factors have received little attention in previous studies but can hamper care transitions if not adequately designed.

The online version contains supplementary material available at 10.1186/s12877-025-06842-4.

• At present, care transitions of older adults in long-term care systems in Germany, the Netherlands and Poland are not optimal.

• Organizational challenges such as communication, transfer of information, and coordination of resources have an immense impact on care transitions and need urgent attention.

• Among financial challenges, reimbursement plays a crucial role when it comes to care transitions in three countries.

The online version contains supplementary material available at 10.1186/s12877-025-06842-4.