A limited entitlement for community care: how members use services

The goal of this paper is to show how members of three Social HMOs use a limited entitlement for community-based long-term care to meet their needs and solve their problems. The paper is based on in-home interviews with 48 aged Medicare beneficiaries who joined Social HMOs and are eligible for the entitlement. Members' experiences with case management (called service coordination), benefits for covered services, and cost-sharing requirements are explored. Members (and their informal caregivers) are found to have complex lives, into which community care fits (or does not fit) in varied ways, depending on preferences, experiences with providers, informal care, financial resources, and other factors. The paper provides insights into what kinds of problems people want to solve and how community care systems can be better designed to empower service users to solve them.