Social Impact Investing

SOCIAL IMPACT INVESTMENT: BUILDING THE EVIDENCE BASE
make a meaningful contribution to these areas it is important to have an understanding of what makes for
good practice in these areas.
5.4.1.1 Services supporting long-term elderly care: what works?
5.58 Increasing demand for long-term care of the elderly in many OECD countries is putting
increasing pressures on many public budgets through increasing health costs (and creating social care
service and pension needs) and this is projected to almost double in most countries over the next 3 decades.
For these reasons integrated care services for the frail elderly have received much attention from
policymakers in recent years. Below are some examples of integrated care practices and their social
outcomes evaluations (focussing on reduction in hospital care) for the frail elderly: 22
A longstanding integrated care service for the over 75’s in Canada (the Programme of Research
to Integrate the Services for the Maintenance of Autonomy or PRISMA) coordinates integrated
care provision through a joint governing board, and in some cases, pooled funds. A Randomized
Controlled Trial (RCT) evaluation of PRISMA found reduced functional decline of programme
participants, more satisfaction with their care, and reduced likelihood to re-use emergency
department services 10 days after discharge (Hebert et al., 2005).
Two small integrated care pilot programmes, Rovereto and Vittorio Veneto, were undertaken in in
two provinces in Italy in the 1990s and provided integrated community-based medical and social
services to the elderly. Evaluations of both programmes showed reductions in acute hospital
admissions, and positive health outcomes amongst programme participants (MacAdam, 2008).
In Victoria, Australia, the Hospital Risk Admission Programme (HARP) pilot provided services
to elderly people who regularly attended hospital emergency departments. Through engagement
with the elderly person’s carer, case management, multi-disciplinary teams, and outreach, the
service achieved a reduction in emergency department admissions (of 20.8%), inpatient care (of
27.9%) and number of bed days for inpatient care (of 19.2%) (Bird et al., 2007).
In England, in 2008, the Integrated Care Pilots programme (ICPs) involved number of
organisations integrating the care of older people with long-term conditions (via case
management or care planning) for the purpose of lowering the risk of hospital admission. The
evaluation of these two-year pilots showed decreases in planned admissions, outpatient service
use and process improvements (e.g. use of care plans, professional training – without associated
measurable social outcomes), but no increase in patient satisfaction was recorded, and there was
no reduction in emergency department admissions (RAND, 2012).
5.59 Services delivery practices that were successful at reducing high cost emergency services use and
hospital care included involving the elderly person’s carer (HARP), case management of individuals,
service planning and single point of entry to multiple service providers (all examples with the exception of
ICPs), multi-disciplinary teams (HARP and Rovereto / Vittorio Veneto), screenings or assessments
(PRISMA, Rovereto / Vittorio Veneto), outreach (HARP), service coordination boards (PRISMA).
5.60 Integration practices are gathering momentum in OECD countries as political interest in cost
effectiveness grows – meaning SII and private social delivery organisations can embrace these approaches,
and find solutions to the specific challenges of working in complex governance settings.
22 . The following evidence is summarised from OECD 2014f, Chapter 3, section 3.5.
76 © OECD 2015