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There is a need to overcome problems resulting from disconnected and fragmented healthcare and social assistance services when it comes to provide integrated care services for the elderly. The concept of integrated care services requires healthcare information services, such as Electronic Health Record, to be up and running not only in hospitals and other healthcare units, but also in social assistance institutions since they take on an important role in providing care for the elderly. This paper proposes a reference model that identifies the processes, procedures and concepts inherent to the functioning of social assistance institutions. This model coupled with an implementation architecture whose flexibility and modularity allows for the gradual development of applications and components reuse. This makes possible to introduce and adapt information services through the involvement of the care providers in a sector that traditionally has had difficulties to incorporate Information and Communication Technology.