Pursuant to a congressional request, GAO reviewed six states’ long-term care case management efforts, focusing on: (1) what constitutes case management, (2) case managers’ roles and performance barriers; and (3) standards for case managers. GAO found that: (1) states use various organizational structures, agencies, and operational approaches to provide case management to the elderly; (2) in all six states, case managers perform five core case management functions including comprehensively assessing client needs, developing care plans based on needs, arranging services, monitoring client status through regularly scheduled contacts, and periodically reassessing client needs and care plans; (3) case managers may perform additional functions that are specific to their agency; (4) the case management process should focus on the client’s medical and social needs, client involvement in service planning, efficient service coordination, knowledge of service providers and the quality of their care, and continued training to maintain and improve case managers’ skills; (5) large caseloads do not allow for accurate monitoring of clients and on-going training for case managers; (6) barriers to effective case management include a lack of financial resources, scarcity of services, and excessive administrative requirements; (7) specific standards for case management functions, caseloads, and case manager qualifications vary from state to state; and (8) two national organizations have established general standards for long-term care case management activities.
