Case management: an American's observations of community care in Britain

The United States faces a rapidly growing aging population, government reforms, and policy shifts to give primary responsibility to the states for programs of community-based care for the elderly. At the same time, increasing concern is being given to the more effective use of home and community-based services, and particularly what role case management might play. Given these changes, much may be learned from the 1993 reforms to the British system of community care, which made case management the cornerstone of the system and gave primary responsibility for community care programs to local social service departments. This examination of the programs in Britain, conducted largely through site visits and personal interviews with social service staff, describes the successes and shortcomings of the implementation of the community care reforms with recommendations for program development in the United States.