Integrating community services provision for older people living with severe frailty: implications from an England-wide survey

Background Older people with severe frailty are nearing the end of life and require community services that span the care continuum, integrating older people’s care (e.g. physical function; rehabilitation) and palliative care (e.g. symptoms; what matters most to the person). Little is known about current community service provision to this population. Objective To characterise the scope of community service provision to older people with severe frailty in England. Methods A cross-sectional online survey design identifying common components and service configurations of community services providing care to older people with severe frailty in England. A self-selecting sample of multidisciplinary care providers from multi-agency community services working with older people with severe frailty with end-of-life care needs. Results Two hundred ninety-eight participants from 102 unique services across all English regions reported information on their service, including frailty and end-of-life assessment, service components, training, service costs and service development. Identification and assessment of frailty and end of life were routinely practiced, but approaches to identification varied. Organisations’ training and development were focussed on their own service provision with little focus on inter-organisational and cross-sectoral working. Conclusions Community care services responses were varied to this population’s diverse needs, which risks less coordinated practice and poorer care outcomes. Poorly integrated services can only partially meet the needs of older people with severe frailty. Further research is needed to address barriers to integration, including cross-sector collaboration, consistent use of appropriate assessment tools and service innovations driven by older people’s expressed needs.