Care management arrangements for older people in England: key areas of variation in a national study

Abstract

Care management has become a key component in the development of community-based care in many countries, and this paper examines the different care management arrangements for older people's services that are now emerging. It has been United Kingdom government policy since  that the providers of social services develop care management systems, as confirmed in the White Paper, Modernising Social Services. The paper opens with the background to the policy changes and a discussion of the role of care management in the British social care system. Secondly, evidence from the early phases of care management development is examined ; and thirdly, the evidence from a major national study of care management arrangements for older people on the patterns of variation on key dimensions is considered. Weiner, Stewart, Hughes, Challis and Darton et al.  ; Challis , a). This latter was particularly associated with two important factors. Enhanced home care for vulnerable people was seen as requiring the degree of individualisation and co-ordination associated with care management. Furthermore, the degree of fragmentation of service provision both within and between social and health care agencies necessitated their co-ordination.It became British government policy in  for local authority social services departments, the main agencies for the provision of social care, to develop care management systems. This was introduced as part of the wider community care reforms embodied in the White Paper Caring for People (Cm  ) and leading to the  National Health Service and Community Care Act, which was implemented in . The policy was driven principally by the budgetary pressures of an ageing population and by funding anomalies. These anomalies had produced a bias in favour of the placement of older people in institutional care rather than the pursuit of a long-standing policy objective to provide care at home (Challis ). New levels of funding and responsibilities were given to social services departments. They were made responsible for undertaking assessments of need, the design and packaging of services tailored to meet such needs, and for the provision of care managers to monitor, review and act as a single point of contact for those receiving services. The more recent social services White Paper reiterated the importance of care management through its emphasis on promoting both independence and user-centred and individually tailored services (Cm  ). Care management antecedents

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

“…In respect of the sample collected at Time 2, there is evidence that the scale and pace of the implementation of the changes consequent on the introduction of the SAP varies between authorities (Abendstern et al, 2007). However, this is also matched by evidence of variation within care management arrangements around the time of the collection of the Time 1 sample (Weiner et al, 2002). Secondly, the data collected at both time periods were taken from samples of case files of older people in receipt of community care services from local authority social services departments.…”

Involving specialist clinicians in policies for integrated care

“…It was seen as a way of addressing problems with assessments such as their variability, lack of specialist contributions and a concern of users over multiple contacts, duplication and lack of coordination (House of Commons Health Select Committee, 1998; Stewart et al, 1999;Weiner et al, 2002;Department of Health, 2002). This paper investigates the impact of this policy by exploring the involvement of specialist clinicians -geriatricians and old age psychiatrists -in terms of: B their assessment practice; B the level/extent of their involvement; B patient/user involvement; and B integrated service delivery.…”

Care management for older people: Does integration make a difference?

“…This paper presents data relating to older people's services, that is those over 65 years of age. Whilst previous papers have reported data relating to services in England (Challis et al, 2001;Stewart et al, 2003;Weiner et al, 2002Weiner et al, , 2003, this is the first publication which seeks to compare provision in England and Northern Ireland.…”