Care Management

he American Geriatrics Society recently adopted a position statement on care management as an important component of an effecT tive and comprehensive geriatric service system. This paper accompanies that statement and attempts to define care management, explore its role in the future of social and health care for the elderly, and emphasize physicians’ roles and the future implications for physicians of proposed or emerging care management policies and programs. A number of significant factors underlie the need for effective delivery mechanisms for coordinated health and social care.’ As the population ages, the number of disabled and chronically ill will increase, and the volume and complexity of service need will increase. Continued escalation of health care costs, driven by the expansion of the heavy-use group (the aged) and by health care cost inflation factors that far outstrip normal inflation, will strengthen efforts to contain costs. Limits to care may be imposed either by resource shortages or by public policy. Adjudication of limitations to care will be needed. The system itself is becoming increasingly complex. Older persons are faced with an expanding menu of housing and community care options. Throughout, we conform to the usage of the AGS position paper, employing the term care management (rather than case management or service coordination) to refer to care planning and the organization of services and resources needed to meet needs and maintain independence. We mean it in a client-centered way that corresponds with the National Council on the Aging’s 1988 standards which emphasize personalized care and client self-determination.’ The concept already has a variety of names and meanings for various health care professionals, managers, and insurer^.^-^ In