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Case-managed care for community-dwelling frail elders

Evidence Rating

Some Evidence

Health Factors

In a case management model, health professionals, often nurses, manage multiple aspects of patients’ long-term care (LTC), including patient status assessment, monitoring, advocacy, care planning, and linkage to services, as well as transmission of information to and between service providers. Case managers often care for frail elderly patients who live independently. Frail elderly patients often have complex health needs that require care from multiple providers, and are at increased risk of adverse outcomes from conditions that could be prevented with early detection and treatment ().

Expected Beneficial Outcomes (Rated)

  • Reduced hospital utilization

  • Improved day-to-day functioning

Other Potential Beneficial Outcomes

  • Improved health outcomes

  • Increased patient satisfaction

  • Increased caregiver satisfaction

  • Reduced nursing home use

  • Improved mental health

  • Improved cognitive function

Evidence of Effectiveness

There is some evidence that case-managed care reduces hospitalization and improves functioning among community-dwelling frail elderly patients when compared to usual care (Hallberg 2004, ). Additional evidence is needed to confirm effects.

Case management can improve patients’ health outcomes (Trivedi 2012) and satisfaction (Hallberg 2004, Trivedi 2012) as well as caregiver satisfaction (, Callahan 2006). In some circumstances, case management can improve quality of care and reduce the need for emergency services () or institutionalization (Hallberg 2004, ). Case management can also improve cognition, reduce depression (), and reduce dementia symptoms in patients with Alzheimer disease (Callahan 2006). Experts suggest that increased rehabilitative care for patients and education for caregivers could improve outcomes further (Hallberg 2004).

Some case management interventions appear to reduce total costs of care while others do not; outcomes vary by program and case manager (Trivedi 2012).

Impact on Disparities

No impact on disparities likely

Implementation Examples

The federal Program for All-Inclusive Care for the Elderly (PACE) offers home care with nurse management for Medicare and Medicaid enrollees eligible for nursing home care but safely able to remain at home (CMS-PACE). This program has demonstrated positive hospitalization (), health, and basic function outcomes ().

The Affordable Care Act (ACA) establishes a demonstration project to test models of nurse and physician-directed primary home care (AOA-ACA). Through the Community Living Assistance Services and Supports (CLASS) Act, ACA also establishes a voluntary insurance program to help participants pay for community living services.

Citations - Evidence

* Journal subscription may be required for access.

Eklund 2009* - Eklund K, Wilhelmson K. Outcomes of coordinated and integrated interventions targeting frail elderly people: A systematic review of randomised controlled trials. Health & Social Care in the Community. 2009;17(5):447–58.

Hallberg 2004 - Hallberg IR, Kristensson J. Preventive home care of frail older people: A review of recent case management studies. Journal of Clinical Nursing. 2004;13(6B):112–20.

Marek 2010* - Marek KD, Adams SJ, Stetzer F, Popejoy L, Rantz M. The relationship of community-based nurse care coordination to costs in the Medicare and Medicaid programs. Research in Nursing & Health. 2010;33(3):235–42.

Trivedi 2012 - Trivedi D, Goodman C, Gage H, et al. The effectiveness of inter-professional working for older people living in the community: A systematic review. Health and Social Care in the Community. 2013;21(2):113-28.

Marek 2005* - Marek KD, Popejoy L, Petroski G, et al. Clinical outcomes of aging in place. Nursing Research. 2005;54(3):202–11.

Eloniemi-Sulkava 2009* - Eloniemi-Sulkava U, Saarenheimo M, Laakkonen M-L, et al. Family care as collaboration: Effectiveness of a multicomponent support program for elderly couples with dementia. Randomized controlled intervention study. Journal of the American Geriatrics Society. 2009;57(12):2200–8.

Callahan 2006 - Callahan CM, Unverzagt FW, Austrom MG, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: A randomized controlled trial. Journal of the American Medical Association. 2006;295(18):2148–57.

Citations - Implementation Examples

* Journal subscription may be required for access.

Grabowski 2006* - Grabowski DC. The cost-effectiveness of noninstitutional long-term services: Review and synthesis of the most recent evidence. Medical Care Research and Review. 2006;63(1):3–28.

AOA-ACA - Administration on Aging (AOA). Affordable Care Act: Opportunities for the aging network.

CMS-PACE - Centers for Medicare & Medicaid Services (CMS). Program of all-inclusive care for the elderly (PACE).

Meret-Hanke 2011* - Meret-Hanke LA. Effects of the program of all-inclusive care for the elderly on hospital use. The Gerontologist. 2011;51(6):774–85.

Date Last Updated

Jan 5, 2015