The case for integrating behavior change, client-centered practice and other evidence-based models into geriatric...

This paper describes the complexities of engaging a frail, elderly population in the process of behavior change to improve daily functioning. Implementation of a brief Purchase of Services (POS) benefit supplementing usual geriatric care management in an integrated, not-for-profit HMO environment is used to illustrate these complexities. Findings from the first two years of the four-year study of the intervention showed that one-third of the group of 541 study participants who were randomized as eligible to participate refused these free, enhanced services. The reasons for these refusals are examined, and a case is made for incorporating behavior change theory into traditional geriatric care management practice for cognitively intact clients in order to facilitate acceptance of needed services and increased patient autonomy.