County Kerry is a rural county in the South-West of Ireland, with a population of about 160,000. The prevalence of cancer is increasing internationally, and this trend is also evident in Ireland. The Kerry Cancer Support Group Health Link Transport (KCSGHLT) is a community-based charity established nearly 15 years ago to provide essential transport services for cancer patients attending treatment appointments. KCSGHLT collaborates with the Health Service Executive, the Irish Cancer Society, and other relevant agencies. It operates independently and is governed by a voluntary board.

Over the first 12 years, KCSGHLT transported more than 6,000 individuals to over 60,000 cancer-related appointments scheduled across 11 hospitals. Currently, KCSGHLT employs 2 staff members and has 6 voluntary drivers, 6 employed drivers, and 12 peer companions. The service operates 5 days a week and does not require a medical referral. Each service user receives a handcrafted blanket as part of their care package at the beginning of their journey, thanks to the support of local knitting groups that meet regularly to create these blankets.

KCSGHLT is an inclusive service, and users report that the bus not only provides invaluable transport but also offers psycho-social benefits and enhances treatment engagement. Economically, using KCSGHLT’s service is highly beneficial; it would cost a person over €500 for private transport, between €400 and €800 for public transport, and over €5,000 for taxis to attend an appointment. However, KCSGHLT provides its services free of charge. Additionally, using the bus helps decrease environmental pollution by reducing individual travel.

We argue that transport is a significant barrier to accessing health and social care for many individuals, particularly in rural areas or where family support and social networks are limited. Furthermore, traveling on the bus offers people the chance to socialise and connect with others who are on a similar cancer journey. Our data indicates that this interaction can improve treatment engagement, and the economic and environmental benefits should not be overlooked.

Policymakers should ensure that appropriate transport structures are in place to make services accessible for everyone and reduce the burden on families. The case of KCSGHLT is a success story demonstrating how local communities can design and deliver essential services needed in their area. The lessons learned from their experience may be valuable for an international audience.

Introduction: The world population is aging, and most people prefer to stay in their homes for as long as possible. There is a growing number of naturally occurring retirement communities (NORCs)—unplanned neighborhoods or apartment buildings with a high proportion of older adults—in many countries such as Australia, Canada, and the USA. To experience healthy aging, older adults living in NORCs must be surrounded by a quality network encompassing both formal and informal support providers. This study aimed to understand the types of formal support providers that older adults interact with and the nature of their interactions.
Approach: We asked older adults to identify professionals or community members who provided them with formal care or support in their daily lives. After identifying these formal support providers, participants completed a short questionnaire about each community support (CS) person. The questionnaire included information about (i) the demographics of CS providers, (ii) the methods used by older adults to contact them, (iii) the type of support older adults received, and (iv) older adults’ level of satisfaction with their relationship with CS providers.
Results: A total of 116 participants from eleven NORCs in 4 cities in Ontario, Canada identified 263 CS providers within their social networks. Participants reported that 60.7% of their CS providers were women, 31% were aged between 46 and 55 years, and 38% were known to them for one to five years. Participants identified the professional roles of 199 CS providers, with family doctors (32%) and spiritual leaders (8.5%) being the most common. Participants reported that almost half of their CS providers (48.5%) supported them with physical health, 18.8% (mostly family doctors and spiritual leaders) offered mental health support, and only 9.7% helped with daily activities and personal care. Participants were very satisfied or satisfied with most of their CS providers (88.1%).
Implications: The findings confirm the crucial role of family physicians in providing support to older adults living in NORCs. Additionally, spiritual leaders were identified by a significant number of older adults in their social network. Therefore, it is essential to include these leaders in the circle of care for older adults to ensure holistic care. Additionally, it is important for other service providers to recognize older adults’ spiritual needs. Future research could investigate how older adults choose different service providers for various types of support over time.

Background: Building on concepts from Complex Adaptive Systems (CAS), this paper proposes an overarching social science framework for addressing the fragmentation that exists in health and social care systems worldwide. The focus is on how relational networks might be strengthened to deliver more coordinated, integrated, whole person-centered care. The framework examines a major planned social experiment occurring in New South Wales, Australia: “All-Inclusive Care for the Elderly” (ALICE).

Approach: Existing research on integrated care has largely focused on structural elements of care with mixed results (Goodwin, 2004; Burns et al., 2022). This approach has largely ignored the complex, emergent, ever-changing relational dynamics of how care is delivered. To address this gap, we merge social network theory (Granovetter, 1973; Kadushin, 2022) and relational coordination theory (Gittell and Weiss, 2004) to develop a relational network theory that addresses the complex ecosystem of health and social care delivery. Network ties involving strength, centrality, density, embeddedness, and structural holes are made “social” by the extent to which the network actors share common goals, trust, mutual respect, and engage in frequent, specific, accurate, and problem-focused communication. These relational processes both influence and are influenced by the structural network properties and impact outcomes.

ALICE is an emerging, neighborhood-based, relational model of care for older people on the Central Coast of New South Wales. Traditionally, healthcare for older people has been complex, fragmented and not focused on social needs. A Relational Network Theory (RNT) framework highlights three core principles of ALICE: 1) the promotion of integrated care delivery through the use of “link workers” who conduct holistic care assessments and coordinate access to care across providers; 2) the development of integrated care communities that leverage social connections and networks through use of kiosks and community engagement officers to support older person care; and 3) a commitment to healthy place-making with local governance and engagement forums to create healthy built and natural environments to support older people in living heathy and active lives.

Results: The ALICE initiative has been co-designed with residents and stakeholders from different sectors to implement an agile approach that will work in different community contexts. This is a foundational step in spreading and scaling outcomes. The relational work in creating new roles (linkage staff, engagement officers) is building the required connections and trust to meet the whole-person needs of older people. A key finding is the need to assess and map the complex social and relational network properties carefully to facilitate successful spread and sustainability.

Implications: Two important implications for providers, managers, and policymakers are: 1) Recognize health and social care delivery as a complex adaptive system (CAS). 2) Co-design new care models following a framework of Relational Network Theory (RNT), building social reciprocity among all actors to reduce the current fragmentation and promote more socially connected care.