The Study of Care Manager Resource Utilization in Long-Term Care
Date Issued
2011
Date
2011
Author(s)
Chen, Nai-Chuan
Abstract
Research Purposes: To reinforce the care for the elderly, the Executive Yuan has approved the Ten Years Long-term Care Program in 2007 and established 25 long-term care management centers in each city among Taiwan, hoping to provide integral and appropriated long term care services through case management system. Care managers are the key persons to provide professional services of case management. However there is no relevant researches on the analyzing the care managers’ actual content of case management practice, nor the local researches discussing the care manager resource utilization in long-term care. The objectives of this thesis are as follows: (1) to analyze the care manager’s actual case management services; (2) to analyze the care manager resource utilization and (3) to explore the important factors affecting the care manager resource utilization.
Research Method: The study subjects are from long-term care management center in Chiayi City who received case management services between January 2010 and July 2010. Total of 702 cases were enrolled in the current study. Sources of information included case service utilization logs and case assessment scale. In the begging, content analysis of case service utilization logs were use to collected different categories of case management services and time required according to each service. After that combined with the case assessment scale, multiple regression analysis were performed to examine the determinants of care manager resource utilization.
Research Results: After analysis, seven categories of case management services performed by the care managers included: (1) case referral; (2) need assessment and care planning ;( 3) connecting services and resources; (4) monitoring ; (5) problem solving and handling conflict ; (6) case closing and (7) administration work。Among the services, need assessment and care planning together with connecting services and resources are considered the most frequent and time consuming services which took care manager’s 90% of total case management time. However, care managers only spent 3.59% of the case management time in monitoring cases under long-term care service. Regarding the care manager resources utilization analysis, the results showed that the average case management work number required for each case is 7.65; and the average case management time required for each case is 192.0 minutes during the study period. There were one fourth of cases consuming only 13% of total case management time while 10% of cases consuming 33.3% of total case management time. This result indicated that only few cases consuming large amount of case management resources. A multiple regression analysis reveals the determinants of care manager resource utilization. Cases with the following factors would consume more case management time including old cases, severe functional impairment, cases with depression, conflict with service provider, caring problem with caregiver ,with other long-term care need members in the family, and cases received the services from number 3 and number 6 care managers. However although in our hypothesis cases with problem behavior and cognitive impairment would affect case management resource utilization, both of them did not reach statistically significant in our study.
Discussions and Conclusions:
(1) Uneven distribution of time spent for different case management work: our study revealed that care manager spent less amount of time in monitoring cases who received case management services. The reasons included incomplete case service utilization logs and heavy case loads. (2) Few cases consumed large amount of care management resources: our study results revealed that cases consuming large amount of care management resources were belong to severe functional impairment cases which indicated that the current long-term care services are mainly social support services. There is short of medical care services for cases with complicated multiple health problems. (3) Factors affecting care manager resource utilization: Cases with problem behavior and cognitive impairment are the two factors in our hypothesis which would affect care manager resource utilization. However due to the lack of training and capabilities for assessing and handling problem behavior cases together with the current long-term service unable to meet the need of cognitive impairment cases, these two factors were not shown statistically significant in our study. (4) The discussion of cases without routine re-assessment: In our study we found 176 cases did not receive routine re-assessment. It is because that the re-assessment is considered as time consuming and complicated work, under the pressure of large amount of case load, care managers would only choose certain cases for the re-assessment.
Policy implications of this study are the following:
(1) Re-evaluation the case management manpower structure and the work content of care managers.
(2) Establish coherent case management service guidelines focus on the timing for re-assessment of the cases and developing screening scales for complicated cases. Establish quality improvement system for care manager’s case management services such as monitoring cases.
(3) Increase case manager training programs to include both assessment and management of problem behavior cases and resources development capability especially for cognitive impairment cases.
(4) Combine resources of health care and social services to enhance the long term care for complicated multiple health problem cases. (5) Re-evaluation the standards of performance assessment and case load for care managers.
Subjects
Long-term care
care manager
care manager resource utilization
Type
thesis
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