A perspective on case/care management from Australia

One of the basic requirements for better health care of older people is proper assessment. Assessment has become a jargon word with attributed meaning when it really describes a necessary process. This process contains four core steps: (1) confirm a medical diagnosis; (2) delineate social situation and resources; (3) determine disability; and (4) decide rehabilitation potential. Through this many people are able to improve their mobility and function by minimizing their disability and handicap, although impairments might remain. A fundamental step that enables the multidisciplinary team to participate effectively in this is goal‐setting, whereby patient/client, the family, and the therapists agree to the plan. The subsequent care plan may result in documentation left with the patient/client, a summary being sent to the local general practitioner, and/or an action plan for therapists/care workers to follow. For staff in the community setting there may be consequent case work (as the therapy input is given), case management (as the total scenario is supported), or case coordination (as various activities are recruited) for a client. In Australia since 1985, under the Commonwealth funded Home and Community Care program, there is significant funding to assist people in their home through the provision of services and support. It has only been more recently that rehabilitation (client relearning skills, equipment being provided, environment being altered) has been acknowledged as providing independence and quality‐of‐life. A new major push has been to support health promotion, illness prevention, and early intervention to prevent later dependency. The role of carers is now acknowledged by the recognition of carers as clients too, in realization of the impact providing care has on carers. Not to be lost in this is the rights of the client versus the needs of the carer. In Adelaide, a new organization, Metropolitan Domiciliary Care, is resulting from the amalgamation of four regional domiciliary care services. City‐wide, it covers a population of 1 million people, gets about 1700 referrals per month, and has over 12 500 active clients. Its role is to support people in their own home and prevent unnecessary institutionalization. A new client intake system for referrals has been devised that prioritizes and streams people to the service delivery system through an initial needs assessment (screening) or provides information and support or referral to another agency. The aim is to have a single common entry point (access) for all clients and then consistent and equitable services supplied across the city. The community care service is provided by 10 regional multidisciplinary teams. This might be a single service by way of therapy, support or prevention activity or a package of care that might need comprehensive assessment and ongoing case management, with multiple services. This development is consistent with the Federal Government's ‘A New Strategy for Community Care Consultation Paper’ (March 2003 CDHA). Although currently focused on the health and care/support of older people it is possible that the same system could assist the Disability and Mental Health sectors. The aim would be to become the provider of choice for integrated community support services for all people with reduced capacity. While Minimum Data Sets will provide the outputs, one of the crucial requirements is to be able to measure client outcomes. This is currently being trialed in pilot stage and the subject of another presentation at this Congress.