Structure and Feasibility of Care Management Across Aging Services

Background and Purpose:  Building off a long history of social workers being involved in care management and health care reform’s promotion of care coordination programs, the demand for geriatric care managers will likely increase across health, mental health and geriatric services. Yet, a lack of clarity persists on the guidelines for who can provide geriatric care management and what constitutes geriatric care management. The purpose of this article is to (1) clarify how managers and staff of adult day services, homecare, senior centers, and supportive housing describe their provision of care management to older adults; and (2) identify barriers to the provision of care management within these service settings.

Methods:  A sequential exploratory mixed methods approach was implemented by first using in-depth interviews with managers (n=20) followed by staff surveys (n=142) within 17 aging network service agencies.  The sample was stratified by four service types: adult day services, homecare services, senior centers, and supportive housing.  Agencies were selected at the recommendation of an expert panel following key informants interviewing protocols, and then the staff were clustered within those agencies. Managers answered closed-ended items about provision of care management within their agency (e.g., frequency of contact, documentation, use of care plans).  Staff described their training, experience, contact with clients, and job responsibilities.  Open-ended items examined perceptions of the care management provided within agencies and barriers to the provision of care management.

Results: Agencies were mostly multi-service, private, non-profit agencies.  All homecare agencies and senior centers reported offering care management services, whereas few adult day services and supportive housing agencies did (Fischer exact, p < 0.05).  Among all agencies, 82 percent reported documenting service use and providing a minimum of two care management contacts with clients during a three-month period.  Yet, less than half reported using and revising a monthly care plan.  The topic of care management and how it is provided generated a great deal of discussion with a primary theme that these services are limited and “as needed” (i.e., “if it hits you in the face”) across all service types and voiced by most managers.  In fact, several managers debated whether or not the term “care management” could be used within their agency, even when the agency had an “official” care management service. The barriers were commonly stated in terms of limited time and resources especially for senior centers and supportive housing that reported caseloads as high as “500 residents”.

Conclusion and Implications: Results revealed a concern about the role, feasibility, and availability of care management services for older adults within these service settings. Polarity between research recommendations and practice applications in regard to care management is a threat to the adoption of empirically supported practices and policy-promoted demonstrations for care coordination.  More research done in collaboration with agency stakeholders can help inform how care managers may become more widespread and feasible across these service settings, and it may help facilitate smoother transitions for the older adult in need of health, mental health and social services.