How do case managers spend time on their functions and activities?

Case management has been a widely accepted approach to practice in community care settings, such as primary health care, community mental health, and community aged care [1]. In Australia, there have been three publicly funded community aged care case management programs/packages (Community Aged Care Package—CACP, Extended Aged Care at Home—EACH and Extended Aged Care at home Dementia—EACHD) that provide different levels of services to community-dwelling frail older Australians. Case managers manage services for a number of CACP, EACH and/or EACHD clients to ensure that they access case management support and case-managed care services (one client uses one care package) [2] (see Table 1).

Case-managed community aged care programs/packages in Australia

CACP program –comparative to low residential care (since 1992)

EACH program-comparative to high residential care (since 2002)

EACHD program-comparative to high residential care (since 2006)

CACP clients

EACH clients

EACHD clients

1) Frail older people aged 70 and over (50 and over if indigenous)

2) Preferring being able to live in the community

3) Assessed as eligible for low residential care

4) Complex care needs resulting from physical, social psychological conditions

5) Needing comprehensive care management ongoing monitoring and review of their changing care needs.

1) Similar characteristics of CACP clients

2) High care needs assessed as eligible for high residential care.

1) Similar characteristics of EACH clients

2) Behavioural psychological symptoms of dementia (BPSD).

CACP services

EACH services

EACHD services

1) Personal care (such as bathing dressing)

2) Domestic care (such as housework, shopping, meal preparation gardening)

3) Social support

4) Transport to appointments.

1) CACP services

2) Carer support

3) Allied health

4) Clinical nursing care

5) Certain mobility equipment

6) Continence consumables.

1) EACH services

2) Special care services (such as dementia care) for addressing clients’ BPSD problems.

Case management support, functions and activities

Typical case management support:

1) Needs assessment

2) Care planning

3) Identifying services that will best meet clients’ needs

4) Arranging additional services through brokerage (brokering/purchasing services from external agencies or persons) or advocacy

5) Monitoring ongoing needs service delivery

6) Staff management related to clients (excluding rostering)

7) Liaising with family members other professionals such as general practitioners

8) Administering packages, including leave, collection of fees suspension of services and case closure if necessary.

Typical case management functions/activities:

1) Developing, monitoring formally reviewing care plans

2) Coordinating negotiating services provided by internal external aged care organisations

3) Providing assistance for clients and carers, e.g. understanding and managing situations, behaviours and relationships; providing emotional support; assisting individuals to access and use general community services/facilities (advocacy); providing one-to-one training or advice

4) Communicating with providing information (such as available services) to clients’ carers/family members.

The literature has consistently agreed that primary case management functions include needs assessment, care planning, implementation, coordination, and monitoring and review [3, 4]. It is difficult, however, to reach consensus on specific case management activities within these functions across care settings and health systems of different countries. Some U.S. studies have investigated different numbers and types of case management activities in various community care settings, or in one particular care setting, such as community mental health and community nursing [5–9]. In addition, a British study has investigated eight case management elements adopted by practice nurses working in the community [10].

Some studies have indicated that outcome evaluation is also an important case management function [11–13], but there are debates on whether it is an independent function or it overlaps or is part of the monitoring and review function in individual case managers’ practice [13]. While some empirical studies (examining frequency ratings of different case management activities) have reported that in their practice case managers perform outcome evaluation activities less frequently than the other case management activities [5, 8, 9], some empirical [13] and commentary studies [12, 14] have revealed that case managers do not perform outcome evaluation adequately because they lack time, knowledge of goals/outcomes and goal setting, capacities, and organisational support.

There has been a paucity of studies based in community aged care that focus on how case managers allocate time to the primary case management functions, or how frequently they undertake those functions and specific case management activities. Some studies have reported that case managers spend considerable time on care coordination as well as more time on initial assessment compared with monitoring and review [14–16]. However, these studies examined different case management function domains (such as direct care, indirect case management, and program management), and/or were based in other care settings but not specifically in community aged care.

In light of the case management approach being employed in various care settings and case management in community aged care having different features in terms of specific target populations, interventions, and approaches to delivering services, how community aged care case managers distribute their time across different functions and activities is of considerable interest [17]. In addition, given the complexity and busy nature of the case management profession, it is of paramount importance for case managers to make the best use of their time in those functions and activities they value. This may improve their work efficiency and the outcome of care [14, 18].

There has been even less research exploring factors that affect case management functions and activities. Some research and review studies have reported that client factors (such as some socio-demographic characteristics and health condition), case manager factors (such as professional backgrounds and length of employment), organisational factors (such as financial restrictions and other organisational policies), and system factors (such as available system resources) influence case managers’ performance of specific functions and activities [3, 19–22], or the overall case management practice [13]. Such great variability in the factors that influence case managers’ practice indicates the necessity to examine significant factors associated with case managers’ functions and/or activities by empirical research.

This study aimed to investigate Australian community aged care case managers’ functions and activities, and significant factors associated with their activities. The research questions included: How do case managers allocate time to case management functions? How frequently do case managers undertake specific case management activities? What are the significant factors associated with case managers’ frequency of performance of their activities? Is outcome evaluation performed frequently by case managers?

We hypothesised that individual characteristics (such as age, gender, caseloads, professional backgrounds etc.), clients’ characteristics (such as percentages of clients living with dementia, living alone etc.) and organisational factors (including size and attributes) would be significantly associated with case managers’ frequency of performance of their activities.