Are different forms of care-management for older people in England associated with variations in case-mix, service use and care-managers' use of time?

Abstract

This paper reports one component of an evaluation of the different forms, types and models of local authority social services' care-management for older people that have emerged in England since 1993. It was undertaken at a time of a growing debate about whether care-management differentiated those with simple from complex needs, and whether for the latter a multi-disciplinary approach was required. A sample representative of different approaches to care-management was selected from a national survey of local authorities to explore the associations between types of care-management and case-mix, the services received by the clients, and the use of staff time. The paper addresses the categorisation of the types of care-management and the differences associated with these. The care-management teams were distinguished by whether they used a ‘targeted approach’, had ‘specialist older people's teams’, or used other arrangements. It was found that those with a targeted approach undertook more multi-disciplinary assessments, provided more assistance to older people with mental health problems, and that their staff spent significantly less time in direct contact with users and carers. Conversely, those with specialist older people's teams had more users in receipt of occupational therapy services. Further research is required to explore the influence of these different arrangements on the wellbeing of service users and their carers.