Over the last years, national and local institutions have implemented strategies to integrate health and social care. At the same time, scientific debate has focused on institutional and organizational interventions aimed at coordinate health providers and social careers. In this debate, the role of patients and their caregivers has been overlooked. With this article, we aim at filling this gap, drawing on a qualitative research carried out in the Province of Trento and focused on the case of elderly people with chronic diseases. In particular, on a practice based approach, we show how family plays a central role, enrolling professionals and informal caregiver, coordinating their actions and fulfilling the holes in the emerging network.
Keywords: Health and social care, elderly patients, networks of care, practice-based studies, inter-organizational networks.