Background. Effective community-based care for older people requires the integration of assessment approaches by old age psychiatry, geriatric medicine and social services care management. This study examines the value of such collaboration in the assessment of older people at risk of entering care homes.

Method. A randomized controlled trial of integrated assessment (care management with additional clinical assessment by old age psychiatrist or geriatrician) versus care management assessment only, for older people at risk of care-home admission. Older people's characteristics, physical and cognitive functioning, depression, behaviour and quality of care measures were recorded at assessment and 6 months. Differences in clinicians' and care managers' recommendations and placement rates between experimental and control groups were analysed. Logistic regression, examining associations between different needs-related characteristics and the likelihood of care-home admission, was used to characterize placement decisions.

Results. Clinicians recommended fewer older people for placement than did care managers in their usual assessments (a reduction of 85%). This did not, however, translate into a reduction in actual numbers of placements, although placements were delayed in those receiving the integrated assessment. Placements of those receiving the integrated assessment were influenced more by clinical factors, most notably cognitive impairment, which clinicians detected more readily than care managers.

Conclusions. In this at-risk group, integrated assessment offers a means of potentially both delaying care-home admissions and taking account of a wider range of factors in placement decisions. Such an approach is viewed as an important policy goal both in the UK and internationally.