Is case management rhetoric or reality? : a survey on the use of case management in Australian residential aged care facilities
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Case management is an integrative and collaborative process of coordinating individual care through assessment, planning, implementation and evaluation. The practice of case management within the residential aged care sector in Australia was explored using a cross-sectional census survey approach. Managers of all Australian residential aged care facilities were invited to participate, with 474 returns (17% response rate) and representativeness between states and territories observed. Using a criteria-based assessment, the survey data identified that 28% of facilities were undertaking case management activities; this population was statistically different from the facilities not meeting the criteria for case management. The survey also highlighted significant pressures for the sector, as reported by Facility Managers. From the perspective of Facility Managers, case management had a positive impact on the facility. Managers identified case management to be associated with improved interprofessional collaboration, undertaking case conferences, increased compliance with care interventions, more accurate funding related to clients? needs, reduced staff workload and improvements in morale and teamwork, as well as a more competent and capable workforce. Undertaking case conferences was not however statistically associated with effective case management processes; collaborative and regular communication with clients and key stakeholders was more beneficial. Compared with previous published findings, residential aged care clients were identified to be more complex and had higher acuity levels. Staff continued to be constrained by high workloads and generally lacked skill and knowledge capabilities, particularly in relation to clinical leadership. An integrative review of the case management literature, combined with the study data led to the development of a recommended case management model suitable for implementation within residential aged care; a system now distinguished by high staff workload and client acuity. The core elements of case management included: preparation (organisational vision, pathways and outcome measurements); implementation (comprehensive assessment and evaluation, reasonable caseload, skilled Case Managers and competent staff); and ongoing evaluation (client and key stakeholder engagement).
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