Academic journal article Care Management Journals

Linking Case Management and Community Development

Academic journal article Care Management Journals

Linking Case Management and Community Development

Article excerpt

Case management, in various forms, is now institutionalized as a core part of policy and programs designed to deliver home- and community-based services to older adults. The case management role, in theory, requires attention to both client and system goals, although in practice the system goals that have received most attention have been gatekeeping and resource allocation. While case managers have been admonished to find and develop resources in the community, this has primarily taken the form of including informal services in individual client care plans. What has been missing is focused attention to the potential of the community as a nurturing environment with the capacity to support older adults and their caregivers. Sustainable care for older adults cannot be achieved by formal service and family support alone. This article proposes the creation of linkages between case managers, who build the service arrangements for older people, and community developers, who are responsible for building community capacity and social capital. It is argued that this linkage is essential for establishing the foundations of a caring community with the capacity to support older people.

Keywords: case management; community development; community capacity building; linkage

Case management is now commonplace in home- and community-based care programs, whether publicly or privately funded. The current state of home- and community- based services is the product of a public policy development process (Polivka, 2000). It is useful to recall that efforts to create a funding base and potentially a delivery system for home- and community-based services date to the early 1970s when Medicaid funded only institutionally based long-term care. In order to establish a funding source for home- and community-based services, it was necessary to amend the Social Security Act. In 1972, Medicare (Section 222 of the Social Security Amendments of 1972, PL 92-603) and Medicaid (Section 1115 of PL 92-603) waivers were enacted, permitting more flexible eligibility and fewer restrictions on the range of services offered in long-term care demonstration projects. A funding source for home- and community-based services was then available for research and demonstration purposes. A series of demonstration projects (Applebaum & Austin, 1990), mounted by various states in selected sites, examined the extent to which coordinated home- and community-based services delivered to eligible individuals could in fact provide alternatives to nursing home care.

Based on the accumulated evidence produced in the long-term care demonstrations, Section 2176 of the Omnibus Budget Reconciliation Act (PL 97-35) was enacted in 1981. This legislation gave the U.S. Department of Health and Human Services the authority to waive the existing requirements of state Medicaid plans. States were then permitted to apply for the so-called "2176" waivers. Services delivered through waivered Medicaid funds could be provided only to Medicaid eligible individuals who were assessed as nursing home certifiable at either the intermediate or skills level of care. The law also specified a range of services that might be offered in community-based long-term care plans provided to eligible individuals These were case management, homemaker services, home health aide services, personal care services, adult day health services, skilled nursing and rehabilitation, home-delivered meals, transportation, and respite care. Case management was thus mandated in federal legislation authorizing the Home and Community- based Waiver (PL97-35).

Case management was central to this programmatic and policy direction for two reasons. It was widely agreed that the delivery system was (and continues to be) highly fragmented. Furthermore, individuals meeting the eligibility criteria for home- and community- based services had complex care needs, requiring systematic and comprehensive assessment and an individualized care plan. …

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