Studies of the Cost-Effectiveness of Social Work Services in Aging: An Updated Review of the Literature

Background and purpose:  The passage of The Patient Protection and Affordable Care Act (ACA) in 2010, which established the Center for Medicare and Medicaid Innovation (CMMI) to identify and fund interventions that improve quality of care while containing costs for older adults, makes urgent the need to document the efficacy and cost-effectiveness of social work service in aging. To build a convincing case for the inclusion of social work services in CMMI funded interventions, and the reimbursement of social work services in general, an updated systematic review of studies focused on social work services in aging was conducted to answer the following questions: (a) What is the current knowledge of the efficacy and cost-effectiveness of social work interventions in aging?; (b) To what extent does the empirical evidence demonstrate the unique contribution of social work to the efficacy and efficiency of interventions in aging?; and (c) Does the current literature provide the empirical evidence to make the case for more flexible Medicare/Medicaid reimbursement of social work services?

Methods: Using multiple indexing terms, the Medline, Social Work Abstracts, PsychInfo, Cinahl and SocIndex-fulltext databases were searched for articles published in English between January 1, 2004 and December 31, 2012 that reported outcomes of interventions for older adults delivered by a social worker(s). Articles were included if they: (a) evaluated an intervention in which social workers were an integral part of the intervention  and (b) the target sample populations included aging individuals and their caregivers/families, or the target outcome variable was related to cost-effectiveness.

Results: A total of 71 articles representing 66 independent outcomes studies were included. The studies fell into seven intervention categories: care coordination/case management/care management (n=18); end-of-life/palliative care/advanced illness (n=13); depression/mental illness (n=11); transitions in care (n=9); caregiving (n=5); geriatric evaluation and management (n=6); and disease management/other (n=4). Approximately half of the studies reported at least one positive outcome associated with improving participants quality of life, including but not limited to, general health status, depression, and functional status. Almost half of the studies examined cost outcomes or cost-effectiveness. The majority of the cost outcomes studies used direct costs (i.e., hospital charges) as outcome measures while others used indirect cost measures that could be linked to cost outcomes (i.e., 30-day readmission rates) or measures for which costs could be calculated (i.e., nursing home placement). Almost all cost outcome studies demonstrated savings/effectiveness.

Conclusion and Implications:  The results demonstrate that social work interventions can positively and significantly impact health care costs and the use of health services as well as the quality of life for older adults. To make a case for the importance of social workers in the aging services field, however, the profession must be able to identify the unique contribution of social workers and connect these contributions to outcomes. There has been a 43% increase in the number of studies examining the effectiveness of social work services in aging since 2003, which suggests that researchers are building an evidence-base for strong the importance of social work services in aging.