Case Management

The nature of any case management service is defined and constrained by the program within which it is embedded (Beatrice; Applebaum and Austin). Therefore, many models of case management have been developed over time, reflecting changes in the goals of specific health and social service demonstration projects and programs designed to serve chronically ill older adults.

Case management in community-based long-term care programs developed in a series of demonstration projects between 1971 and 1985 (Kemper et al.; Applebaum and Austin; Cargano et al.). In 1971 no mechanism for funding in-home and community-based services was available, so it was necessary to identify funding to support the development of a community-based delivery system. Funds were made available through a waiver of the traditional restrictions imposed by the standard Medicare and Medicaid programs. This permitted the expenditure of funds for services provided outside of hospitals and nursing homes. These projects sought to demonstrate the development of a comprehensive and coordinated system of in-home and community-based services for older adults that would make available alternatives to premature or inappropriate nursing home placement. The projects also investigated whether communitybased services would cost less than nursing home care for eligible clients. Although these demonstrations differed in a variety of ways, they all included case management and an expanded array of in-home and community-based services. In these projects, case managers were nurses and social workers. They were responsible only for coordinating care plans that included in-home and community-based services. They had limited involvement with, and no authority in, the traditional health care system that provides primary, acute care, and skilled in-home nursing services.