Existing training (including supervisions) to enhance case manager’s skills

The case manager has the skills to recognise the signs of social isolation, based on the multidimensional geriatric assessment and clinical judgment during regular home visits.

The older people and their informal caregivers feel recognized in their needs of meaningful social contacts

The older person experiences social support

Physical accessibility of adequate day care centres

The case manager encourages meaningful activities to the older person, such as weekly visits to day care centres

The proposed activities make sense to the frail older people and their informal caregivers

The proposed activities induce a feeling of social utility because of the reciprocity of the social interaction.

Financial and geographical accessibility to services

The case manager identifies barriers to access the meaningful activities and proposes services to address them (financial, geographical)

The older people feel they are able to access these activities and anticipate they can benefit from them

Observing peers with similar conditions strengthen the older people’s and their informal caregivers’ belief that they can succeed in remaining at home

Adequate caseload of the case manager (< 40 frail older person/FTE case manager) allows for sufficient time spent to identify significant others

The case manager identifies significant others who can support meaningful social interactions with the frail older persons

The older people and their informal caregivers feel socially and emotionally supported by significant others

The older person does not feel supported socially