With the move towards consumer directed care, case managers see their future role being more about motivation and education and less about managing budgets, according to research from the University of Melbourne.
Dr Emily You from Melbourne School of Population and Global Health targeted all 110 of Victoria’s community aged care organisations providing publicly funded case-managed community aged care packages and HACC programs to discover case managers’ perspectives on their practice, goals and outcomes as part of her PhD research.
Among the findings, which are based on 154 survey responses and 33 interviews, case managers raised concerns over how consumer directed care would impact their role in the future, Dr You said.
“Generally case managers perceived they would face greater challenges because this is new policy and it will impact on their role in the future. One major concern is whether case management would be needed later if clients can manage their budgets and their care themselves,” Dr You told Australian Ageing Agenda.
She said senior case managers and top level managers were the most optimistic about the future of case management
“From their perspective, they think case management would be needed in the future but the difference is case managers would focus on a more motivational role.
“At this stage, case managers are doing many basic tasks and clients just depend so much on case managers. But in the future, if clients can take on some responsibilities then case managers would perform education roles providing information and even stepping back and letting clients manage their budgets [and] just provide support when necessary,” Dr You said her research found.
Effectiveness of case management
As part of her research Dr You produced two systematic reviews evaluating the effects of case managers and found positive results in terms of client outcomes and cost neutrality.
“There were some positive findings regarding case management as a profession or kind of intervention. It can improve client health outcomes, quality of life and psychological wellbeing.”
She said her findings did not provide evidence to support the concern that case management would result in increased costs.
Factors impacting practice
The study, which looked at the factors impacting on case managers’ practice, found that professional background was a big influence. Nurse case managers tended to be task oriented and were focused more on medical issues while social worker case managers emphasised a systematic and holistic approach. These approaches complemented each other because case managers worked in teams sharing knowledge and helping each other, said Dr You.
The research also found that clients born outside of Australia or from CALD communities were often more difficult to manage because of different cultural and family values and language barriers, Dr You said.
Organisational factors impacting on practice related to the organisation’s expectations in light of limited budgets, a factor which often resulted in a conflict of goals.
“Organisations would expect case managers to use money wisely but also meet client planned goals. Sometimes there is a kind of conflict because they didn’t have enough money. Clients had a lot of things they wanted to achieve so case managers find it difficult to balance client expectations and organisation expectations,” Dr You said.
Another conflict related to organisations expecting case managers to undertake a lot of administrative tasks, such as documentation and paperwork, but case managers would also like to spend a lot of time face-to-face with their clients, she said.
“They found it difficult to manage but they didn’t directly tell me if they could or couldn’t. They just sometimes expressed frustrations or concerns about how the organisational policies can be revised to support them to manage multiple tasks better because from the case managers’ perspectives, both are important.”
Dr You’s recommendations for future research include further exploration of the impact of consumer directed care on case management to evaluate the effects of this new care approach on clients, case managers, organisations, and care delivery systems.