Are different forms of care-management for older people in England associated with variations in case-mix, service use and care-managers' use of time?

Abstract

This paper reports one component of an evaluation of the different forms, types and models of local authority social services' care-management for older people that have emerged in England since 1993. It was undertaken at a time of a growing debate about whether care-management differentiated those with simple from complex needs, and whether for the latter a multi-disciplinary approach was required. A sample representative of different approaches to care-management was selected from a national survey of local authorities to explore the associations between types of care-management and case-mix, the services received by the clients, and the use of staff time. The paper addresses the categorisation of the types of care-management and the differences associated with these. The care-management teams were distinguished by whether they used a ‘targeted approach’, had ‘specialist older people's teams’, or used other arrangements. It was found that those with a targeted approach undertook more multi-disciplinary assessments, provided more assistance to older people with mental health problems, and that their staff spent significantly less time in direct contact with users and carers. Conversely, those with specialist older people's teams had more users in receipt of occupational therapy services. Further research is required to explore the influence of these different arrangements on the wellbeing of service users and their carers.

Emergent Approaches to Care Coordination in England: Exploring the Evidence From Two National Organizations

“…Inthesecondstrand,informationwastakenfromtwonational postalsurveysofcarecoordinationarrangementsinEngland.The firstsurveywasrelatedtoLAcare management in older people's services and was derived from earlier studies (Challis, Darton, Hughes, Huxley, & Stewart, 1998;Challis, Hughes, Jacobs, Stewart, & Weiner, 2007;Weiner, Stewart, Hughes, Challis, & Darton, 2002). Questionnaires were distributed to all LAs in Englandin2006.Aresponserateof79%(118of149LAs)was achieved.ThesecondsurveywasrelatedtoPCTcase management for people with long-term conditions.…”

Developing multidisciplinary assessment—exploring the evidence from a social care perspective

“…Case files of consecutive referrals for care management from the 4 January 2000 or as soon as possible thereafter were included (Challis et al, 2007). This comprised the comparison or historical control group (Bowling, 1997).…”

“…Evidence of physical dependency was defined as scoring two or more on this scale. Case files were interrogated for evidence of mental health problems including problems with cognitive skills, communication, behaviour, and short-term memory as these are often associated with dementia in older people (Challis et al, 2007). Evidence of problems with cognitive skills (cognitive impairment) was thought to be the most appropriate proxy measure for evidence of a mental health problem.…”

Nurse-led case management in the National Health Service: bridging clinical and social worlds

“…Challis et al (2005) found that closer communication across the professions resulted generally in less time needing to be spent on care planning and case review in the minority of social services departments that have NHS staff working alongside social workers. Challis et al (2005) found that closer communication across the professions resulted generally in less time needing to be spent on care planning and case review in the minority of social services departments that have NHS staff working alongside social workers.…”