Home care : evaluation of a case management model

Increasing numbers of older persons, service provision within the home and shrinking resources have resulted in the need to evaluate service provision. This study examined agency process and client-perceived health in a single point of entry case managed program in a community health centre. The participatory evaluative model involved a dossier review, interviews with workers, and a description of client functioning using the SF-12(TM). Examination of files (N = 100) revealed that objectives were not being obtained: client involvement was low, services were late, and files were poorly completed. Only 14 (9%) of clients were referred for the SF-12(TM); further investigation revealed systemic difficulties such as lost clients (N = 4). Worker interviews (N = 12) explained that heavy caseloads result in reactive services, poor completion of case management functions, and service implications for clients. Strengths included the multi-disciplinary approach and single point of entry. Recommendations include a cost benefit analysis, an outcome measure, a caseload standard and a quality assurance model that assures accountability and monitoring