Determining caseloads in the community care of frail older people with chronic illnesses

Abstract

The purpose of this paper is to discuss and critique the literature related to the measurement of caseloads by sociomedical case managers in the context of community care for frail older people. As a result of reduced mortality rates, there is an ageing, chronically ill population in need of long-term continuity of care. Case management is a model of care designed to maintain the quality of life of frail older people living in the community whilst constraining the associated costs of care. A review of the literature was undertaken to examine methods of determining caseloads for frail older people in the community setting to identify where investigations are absent or not robust. An absence of empirically tested approaches to determining caseloads and the wide variability in caseloads in caring for frail older people was evident. Predictors of variations in case management resources have been described at both the programme and client level, although controversy about the validity of these predictors, such as age and functional status, has been reported. The ageing population is a vulnerable group, and is entitled to live out their lives in the comfort and familiarity of their own homes where possible. Coordinated and supportive healthcare organizations and health system policies are critical to support empirically tested caseload indexes. These findings have implications for quality of care, planning and workforce policy development for our increasingly aged society. Recommendations for further research conclude this paper.