The role of case managers in a United Kingdom experiment with self-directed care

While the concept of consumer-directed care is becoming increasingly popular in the U.S., little is known about how such programs work or the critical role of case managers within them. This article reviews a 5-year initiative in the United Kingdom in which severely disabled, chronically ill adults were given cash to pay for in-home care which they themselves arrange. The genesis of the program and how it operated are described here. In particular, the responsibilities of case managers are outlined along with their role in determining the amount of assistance needed by clients in the program. A profile of program clients is also provided with data on their levels of in-home support.