Long-Term-Care Case Management:

State Experiences and Implications for Federal Policy

HRD-93-52: Published: Apr 6, 1993. Publicly Released: Apr 6, 1993.

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Pursuant to a congressional request, GAO reviewed six states' long-term care case management efforts, focusing on: (1) what constitutes case management, (2) case managers' roles and performance barriers; and (3) standards for case managers.

GAO found that: (1) states use various organizational structures, agencies, and operational approaches to provide case management to the elderly; (2) in all six states, case managers perform five core case management functions including comprehensively assessing client needs, developing care plans based on needs, arranging services, monitoring client status through regularly scheduled contacts, and periodically reassessing client needs and care plans; (3) case managers may perform additional functions that are specific to their agency; (4) the case management process should focus on the client's medical and social needs, client involvement in service planning, efficient service coordination, knowledge of service providers and the quality of their care, and continued training to maintain and improve case managers' skills; (5) large caseloads do not allow for accurate monitoring of clients and on-going training for case managers; (6) barriers to effective case management include a lack of financial resources, scarcity of services, and excessive administrative requirements; (7) specific standards for case management functions, caseloads, and case manager qualifications vary from state to state; and (8) two national organizations have established general standards for long-term care case management activities.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Bills that included provisions for long-term care case management in keeping with the recommendation were considered, but not adopted, during the 103rd Congress. At present, similar legislation has not been proposed and there appears to be very limited interest in specifying even broad federal standards for case management.

    Matter: If Congress wishes to encourage more standardized case management by the states as part of its long-term-care initiatives, it should consider establishing broad standards for the core case management functions and case manager qualifications, and defer to state and local discretion such specifics as caseload size, client contact, and required education level and experience.


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