Linking Community Care and Health Care: A New Role for Secondary Health Care Services

<p>The provision of effective long-term care at home for frail older people requires planned and coordinated inputs from health and social care agencies. This is evident from a range of research studies (see, for example, Challis et al., 1995) which indicate the interplay between social care needs and clinical phenomena, and which have been reinforced by policy guidance. For example, although the level of functional impairment is an important influence upon the probability of placement in residential settings, so too is the presence of certain diagnoses (Tsuji et al., 1995; Darton et al., 1997). Rockwood et al. (1996) found that entry to a long-term care facility was associated not only with social factors and functional difficulties, such as female gender, being unmarried, the absence of a caregiver, the presence of cognitive impairment and functional impairment, but also with clinical diagnoses, such as diabetes mellitus, stroke and Parkinson's disease. They concluded that frailty is multidimensional and not simply a synonym for dependence in activities of daily living. Furthermore, the importance of the psychosocial needs of older people and their carers as determinants of placement has been identified in several studies (Jorm et al., 1993; Tsuji et al., 1995). For some individuals, particularly those with complex needs, a primary health care-led NHS may be insufficient, lacking both the range and depth of response necessary. The key question, therefore, is how to combine what kinds of inputs, whether primary or secondary, health or social, for which individuals, in what ways.