Challenges Facing Case Management in a Changing Social Service Environment
Lee, Brason Msw, Msg, Care Management Journals
Case management has been a difficult practice to track, particularly for the purposes of outcome measurements and accountability. As both policymakers and program administrators consider options for providing long-term care, the Data Analysis and Regulations Team of the California Department of Aging studied computerized client information for one of its case management programs to examine what we know about the people being served and the ability of the data collection system to meet the increasing demand for accountability. This article details the results of our study and discusses their implications within the dynamics of a changing social service environment.
There are two forces converging in the nation's health and social service arena. One of them is the growing movement toward developing community-based alternatives to institutional care. This trend targets the needs of 12.8 million Americans who require assistance with everyday activities as a result of chronic health or medical conditions. Over three-quarters of them live at home or within the broader community. More than half of those living in the community are persons aged 65 years and over (U.S. General Accounting Office, 1994).
In California, one of the state's community-based long-term care programs serving this population is the Linkages program (Linkages). This is a case management service offering help to frail older persons and disabled adults in order to help them maintain their independence at home for as long as possible. Linkages uses a social service model to connect its clients to community resources that are appropriate for their level of need(s). They include, but are not limited to, assistance with driving to medical appointments, cleaning the house, or delivering meals to the home. Since its conception, Linkages has experienced a 73 percent increase in the total number of clients it has served from an estimated 2,600 in fiscal year 1985-1986 to 4,499 in fiscal year 1999-2000.
The other force converging in the health and social service arena is the growing movement toward evaluating programs from the point of view of outcomes and accountability. The goal for looking at outcomes and accountability can vary depending upon the interests of the organization housing the program, so as to better coordinate the delivery of services, to enhance the quality of care, and to control the increasing cost of health services, among many other interests (Aliotta, Aubert, Kirby, 1998; Hu & Jerrel, 1998; Borgenight, Carty & Feigenbaum, 1997; Srebnik et al., 1997). The U.S. Congress has also made a commitment to improving the performance and accountability of the programs it funds by passing the Government Performance and Results Act of 1993 (Public Law, 106-501).
As California and the nation consider options for providing long-term care, the goal of the study is to describe the characteristics of clients enrolled in Linkages and to discuss their implications within a changing social service environment.
For the purposes of this study, we reviewed data collected through the State of California's Datalnk database-a client-level databank containing records on every person served by Linkages. We focused on all active cases during fiscal year 1998-1999. Cases that were excluded from this study are those that did not have documentation of an assessment date, annual reassessment date for cases open longer than a year, or conflicting dates of assessment and termination. The final sample included 2,043 confirmed cases. These cases are unduplicated, meaning that each case represents a single person regardless of how often he or she might have enrolled in and discontinued from the service. Statistical analyses were conducted using the Statistical Package for Social Sciences Program.
Thirty-eight percent of all sites were located within a governmental (public) agency and 31 % were located within a health care organization. …