Allocation of case management resources in long-term care: predicting high use of case management time

The expansion of publicly funded home care services and case management (CM) programs has fueled concerns about containing the costs of these programs. For CM practice, the issue is one of tailoring CM to those who really need it and are most likely to benefit from it. This concern calls for a better understanding of factors that increase the need for CM resources, defined as the use of CM time. This study of 242 clients in a Medicaid-waiver-funded home care program found clients' problem behaviors, higher functional ability, informal support problems, and problems with service provider agencies to be predictive of greater use of CM time. These findings suggest the need to develop appropriate assessment of problem areas, implement effective protocols to manage specific problems, and address such issues as appropriate levels of staffing and provider accountability.