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A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues.

This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness.

In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161).

There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners.

The purpose of this paper is to describe the development, implementation and initial evaluation of the Geriatric Flying Squad's reciprocal referral pathways with emergency responders including New South Wales Ambulance, Police and Fire and Rescue. These innovative pathways and model of care were developed to improve access to multidisciplinary services for vulnerable community dwelling frail older people with the intent of improving health and quality of life outcomes by providing an alternative to hospital admission.

This is a case study describing the review of the Geriatric Flying Squad's referral database and quality improvement initiative to streamline referrals amongst the various emergency responders in the local health district. The implementation and initial evaluation of the project through online survey are further described.

Sustainable cross-sector collaboration can be achieved through building reciprocal pathways between an existing rapid response geriatric outreach service and emergency responders including Ambulance, Police, Fire and Rescue. Historically, emergency services would have transferred this group to the emergency department. These pathways exemplify person-centred care, underpinned by a multidisciplinary, rapid response team, providing an alternative referral pathway for first responders, with the aim of improving whole of health outcomes for frail older people.

Enablers of these pathways include a single point of contact for agencies, extended hours to support referral pathways, education to increase capacity and awareness, comprehensive and timely comprehensive assessment and ongoing case management where required and contemporaneous cross-sector collaboration to meet the medical and psychosocial needs of the client.

The Geriatric Flying Squad reciprocal pathways are a unique model of care with a multi-agency approach to addressing frail older people's whole of health needs.

The purpose of this paper is to emphasize the need for holistic geriatric health care in rural India. Many older people in Indian villages suffer from chronic ailments without any relief or intervention because of inaccessible and unaffordable health-care services. This paper explores how holistic health care can be assured for older people in Indian villages.

This paper is based on reflections of the authors who have had experiences as caregivers to older persons within their respective families rooted in the Indian villages. Besides, they interacted with 30 older persons (18 males and 12 females in the age group of 60–80 years) living in the villages in three states of India, namely, Haryana, Rajasthan and Madhya Pradesh to develop a comprehensive viewpoint on the need of geriatric health care in rural India. Relevant reports, newspaper articles and research papers were also reviewed while developing viewpoints on such an important topic.

Geriatric health-care facilities in rural India are abysmal. The older people in the villages cannot leverage health-care facilities that are generally inaccessible, inadequate and unaffordable. Even the government support for medical treatment is minuscule. Furthermore, there is lack of trained health-care professionals at all levels, namely, doctors, nurses and paramedic personnel. Training opportunities in geriatrics are also negligible. The scenario vis-à-vis geriatric health care in rural India can be upturned by increasing public spending on health-care infrastructure, increasing numbers of health-care professionals and expanding training programmes in geriatrics.

This paper is based on the critical reflections of the authors as well as their informal interactions with some of the older people in the Indian villages.

The purpose of this paper is to introduce problem-solving therapy (PST) training to an Ontario health region. The aim of this pilot project was to increase psychotherapy access by training community-based outreach clinicians and to understand their satisfaction with the training program as well as their confidence in applying the principles of PST.

Clinicians from Southwestern Ontario who provide community-based mental health outreach services to older adults were invited to participate in this training opportunity. Selection was based on their existing client base, the geographic area they served, and self-reported foreseeable PST training benefits. Selected individuals received an eight-hour in-person didactic session, eight one-hour case-based learning opportunities, and individual case supervision. Acquired knowledge, perceived confidence in their skills, level of adherence to PST principles in clinical interactions, and satisfaction with the training program itself were measured.

Of the 36 applicants, eight trainees were selected. All trainees completed their training and seven were successfully certified in PST. Trainees indicated a high level of satisfaction with the training experience. According to the evaluation tools, trainee confidence in providing PST significantly increased, though there was no statistically significant change in knowledge.

This study provides the first evidence that PST can be introduced within a regional geriatric mental health service in Canada. The training involved both in-person training, web-based conferencing sessions and a supervisory component. The training lasted 16 hours and resulted in staff skill development in an evidence-based psychotherapy modality.

The purpose of this paper is to investigate whether first level measures in the Balanced Scorecard (BSC) declaring a cause-effect relationship by design are composite indices of lower measures, and if they converge into a single factor as is traditionally accepted in the BSC literature.

This study reports results of a quantitative case study that focusses on an Ontario (Canada) community hospital that has been using the BSC.

The results of this study challenge the cause-effect assumption of the BSC, particularly in a cascading context, and suggest that a lack of attention of how composite indices of lower measures converge into a single higher level measure may be the reason for ineffective use of the BSC.

The BSC is a dynamic tool; as such there are several measures that have a very short history, thus limiting the observations available to be used in statistical models.

A key recommendation for practice that emerges from this study is the need to test if lower level metrics do merge naturally in the upper level measure of the BSC; if not, the upper level measure might not be linked to other measures rendering the BSC ineffective in the context of causality.

Although several studies have argued in favour of the cause-effect relationship of the BSC, none of those found in the literature have paid attention to the way in which first level measures are constructed. This may explain why certain measures are linked, while others are not, to those that are calculated as composite indices of several lower level indicators.

The purpose of this paper is to describe an American healthcare organization's experience creating the first multi-facility trauma system managed by a private, nonprofit organization.

A leadership structure was established to initiate the first steps of system development, followed by needs assessments that identified key components essential to creating the interconnected system. The key components were applied as a result of evidence-based system development. After system implementation, early benefits were explored.

Data collection and research, prehospital support, system-wide quality improvement, rural outreach, communication, and system evaluation were identified as key components essential to creating an interconnected trauma system. The system currently connects 12 trauma centers throughout the state of Colorado while working within the parameters of an established statewide system. Early benefits included improved designation review results, the utilization of system-wide best practice protocols, a rich trauma registry, and closer relations with rural, out-of-network facilities.

This study describes the process undertaken to implement a unique medical system that provides regionalized care and complements an existing statewide trauma system. The authors hope their experience may serve as a roadmap for healthcare professionals wishing to develop an integrated, patient-centered model of care.

The development of this multi-facility trauma system within a private, not-for-profit healthcare organization is the first of its kind.

The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.

This is a descriptive paper summarizing population and program data about rural veterans.

VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.

This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.

Type 2 diabetes mellitus has become a major concern of Australian healthcare providers. From rates of barely more than 1 percent in the mid-90s, diabetes is now the leading cause of morbidity in the country. To combat the growing diabetes epidemic, Western Sydney Local Health District created the Western Sydney Diabetes (WSD) initiative. One of the key components of the WSD initiative since 2014 has been joint specialist case conferencing (JSCC). The purpose of this paper is to evaluate the JSCC service including both individual- and practice-based changes.

The authors evaluated the JSCC program by conducting an analysis of patient-level data in addition to a discrete practice-level study. The study aim was to examine both the effect on individual patients and the practice, as well as acceptability of the program for both doctors and their patients. The evaluation included data collection and analysis of primary patient outcomes, as well as a survey of GPs and patients. Patient data on primary outcomes were obtained by accessing and downloading them through GP practice management software by GP practice staff.

The authors found significant improvements at both the patient levels, with reductions in BMI, HbA1c and blood pressure sustained at three years, and at the practice level with improvements in markers of patient management. The authors also found high acceptability of the program from both patients and GPs.

This paper provides good evidence for the use of a JSCC program to improve diabetes management in primary care through capacity building with GPs.

Describes how closure of hospital long‐stay wards for the frail elderly and their replacement by care in the community has led to a mismatch of skills and patients. Restrictive practices within the medical profession, and rigid adherence to the existing referral system from general practitioner to hospital consultant can operate against the interests of patients in the community. Some means must be found to bring skilled medical care to patients in residential and nursing homes. If this cannot be achieved within existing NHS structures, local authorities and the private sector should consider appointing their own consultants to liaise with NHS personnel as necessary.

This paper analyses how neighbourhood governance of social care affects the scope for frontline workers to address health inequities of older ethnic minorities. We critically discuss how an area-based, generic approach to service provision limits and enables frontline workers' efforts to reach out to ethnic minority elders, using a relational approach to place. This approach emphasises social and cultural distances to social care and understands efforts to bridge these distances as “relational work”.

The authors conducted a two-year multiple case study of the cities of Nijmegen and The Hague, the Netherlands, following the development of policies and practices relevant to ethnic minority elders. They conducted 44 semi-structured interviews with managers, policy officers and frontline workers as well as 295 h of participant observation at network events and meeting activities.

Relational work was open-ended and consisted of a continuous reorientation of goals and means. In some cases, frontline workers spanned neighbourhood boundaries to connect with professional networks, key figures and places meaningful to ethnic minority elders. While neighbourhood governance is attuned to equality, relational work practice fosters possibilities for achieving equity.

Further research on achieving equity in relational work practice and more explicit policy support of relational work is needed.

The paper contributes empirical knowledge about how neighbourhood governance of social care affects ethnic minority elders. It translates a relational view of place into a “situational” social justice approach.