The third sector as a means of coordinating person-centred social care for older adults

Abendstern M, Hughes J, Jasper R, Sutcliffe C, Challis D. Care co-ordination for older people in the third sector: Scoping the evidence. Health & Social Care in the Community. 2018; 26(39): 314-329.

Review question

•       What is the role of the third sector (non-profit organizations) in the coordination of social care for older adults?

Background

•       As the average age of populations rises globally, it is important to find ways to ensure that older adults remain healthy, engaged and autonomous.

•       In most developed countries, this support has traditionally been provided by health and social-care agencies, who appoint a central care coordinator to ensure the overall cohesion and quality of care among various providers for one individual.

•       The key functions of care coordination include identifying needs and goals, devising support plans, and arranging appropriate care and support.

•       Unlike the United States and Australia, where third sector (non-profit) and for‐profit organizations have been the main providers of care coordination for many years, in the United Kingdom the role of the care coordinator has predominantly been undertaken by social workers, nurses and occupational therapists.

•       The aim of this systematic review is to examine the role of the third sector in the coordination of social care for older adults.

How the review was done

•       Review authors conducted a search of numerous research databases for 2013 and 2014. The searches were updated in 2016 to ensure the relevance of previous search results.

•       Articles were eligible for inclusion if they were written in English, included observational data, and focused on care coordination, older adults (aged 65 and over), and the third sector.

•      A total of 835 articles were retrieved from the initial search, of which 26 were included in this review.

•      This review was commissioned by the National Institute of Health Research and the School for Social Care Research. No conflict of interest was reported by the authors.

What the researchers found

•       Overall, the review revealed very little literature focused on the coordination of social care for older adults.

•       According to one of the included studies, third-sector care managers take on a variety of roles including: functional, social and financial assessments; ongoing monitoring; planning, referral and coordination of services; and assistance with form completion.

•       Over one-quarter of the literature described third-sector services as a person-centred practice with a focus on understanding the person, engaging in decision-making, and promoting the care relationship.

•       Older adults were found to value the more informal and less bureaucratic approach of third-sector service providers. They also reported a preference for staff who listened with respect and empathy, and took a holistic perspective and a partnership approach.

•       Service users reported a sense of security when using third-sector care-coordination services, due to their expertise and knowledge along with an ability to communicate in a way that is accessible to the service users.

•       One study indicated that staff reported that the integration provided by care coordinators enhanced interprofessional learning, clinical knowledge and working collaboratively.

•       Maintaining and improving the quality of third-sector care-coordination services was an issue raised by managers and staff in over one-fifth of the included studies. For the most part, staff were concerned about the lack of evaluation and regulation of third-sector care managers.

•       According to review authors, the main implication of the findings was a need to nurture variety within the third sector in order to provide older adults with the range of service options desired.

Conclusion

•       This review provided a comprehensive overview of the roles of third-sector care managers, along with perceptions of their efficacy by care users and staff.

•       Areas for future research include the need for a specific focus on older adults’ experiences, as well as examining workforce issues, third-sector practices, outcomes and costs, and quality-assurance systems.