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Social Work and Social Services

This paper describes variations in case-management approaches in twelve demonstration projects of long-term community care of the elderly in the USA. The authors describe case management as a service that directs client movement through a series of phased involvements with the long-term care system and which attempts to integrate the formal long-term care system with the care giving provided informally by family, friends and community groups. There are five readily identifiable components to the case management process: (1) Intake and screening — the initial process of identifying potential clients through referrals and procedures to determine eligibility. (2) Assessment and reassessment acquiring relevant information about medical, functional, social and emotional status and service needs. (3) Care planning the development of a care plan based upon the assessment which specifies the services to be delivered, their frequency, duration and objectives. This will involve meetings with the client, informal carers and formal caregivers. (4) Service arrangement the process of contacting service providers, the client and family to arrange for the implementation of the care plan. This will include negotiation, ensuring service availability and developing substitute services. (5) Monitoring and counselling this involves ongoing contact with the client and informal carers to check on well-being and satisfaction and to identify emerging service needs. Counselling or advice are likely to be provided during monitoring or in response to a crisis. Two areas were considered where case management approaches appeared to differ in a noteworthy fashion. These were (1) the staffing and task allocations and (2) the procedures for controlling service use and costs. Two dimensions of staffing and task allocation were examined: (a) the degree of professionalisation referring to the proportion of staff who were professionally qualified and (b) the degree of specialisation referring to the extent to which individual staff performed all the case-management tasks for a given client or only undertook certain tasks. Two aspects of control of service use were also examined: (i) the scope of case-management control over a range of services and (ii) whether there were expenditure ceilings. It was observed that there were considerable variations in the approaches to case management with regard to the professional levels