WACKER, R.R., ROBERTO, KA, PIPER, L.E.: Community Recources for Older Adults. Programs and Services in an Era of Change. Pine Forge Presss, Thousand Oaks-London- New Delhi www.hud.gov This is the place to start Id look lor information about housing policy or programs. Visitors can search USDHUD's database and gain access to housing reports, program information, and a variety of housing data. The site also has consumer information about housing. HomeStore.com: Senior Living www.springstreet.com/seniors/index.ihlmWsource-ahnHjf597 This Web site displays buildings, grounds and interiors of retirement communities, assisted living facilities and nursing homes in color photographs. Detailed information on each properly may also be found, as well as names of moving companies, self-storage, financing, and retirement planning books. Mature Market Resource Center www. seniorprograms, com The Mature Market Resource Center has two Web-based organizations. First, the Associalion of Marketing and Sales Executives in Senior Housing is a Web-based national membership organization dedicated exclusively to the needs of marketing, sales, and communications executives in senior housing. Second, the National Association of Senior Health Professionals is a Web-based membership organization specifically designed to address the unique needs and special interests of professionals in the rapidly growing Field of senior health. Assisted Living Federation oF America |ALFA) www. a/fa. org ALFA's Web site provides information to consumers, including a sample resident agreement, videotapes ta help consumers and families ease the transition lo senior housing, and a directory of ALFA members. 10 Case Management Ruby, 86, suffers from Parkinson's disease. Widowed for 5 years, Ruby lives in a small house one block from the main street of the town in which she has lived far 25 years. Ruby is becoming quite frail and must always use a walker. She has wonderful neighbors who are helpful, a 767ear-old sister-in-law who lives 5 miles away, and two nieces who are caring and attentive but live out of state. Ta help her remain independent and to continue to live in her own home, Ruby's case manager recommended a variety of service options, including meals on wheels, home health care, and the use of the senior bus for visits lo the doctor when her neighbors are not available to lake her. Case management is central to the integrative delivery of services for older adults. Without it, many older adults such as Ruby become frustrated when seeicing help from an often fragmented, complex, and costly service system. Case managers serve as navigators, guiding older persons in their pursuit of services that will foster their independence. The National Advisory Committee of Long-Term Care Case Management defines case management as "coordinating services that helps frail elders and others with functional impairments and their families identify and secure cost effectively administered services appropriate to the consumers' needs" (Connecticut Continuing Care, Inc., 1994, p. 5). This dual mission of planning and individualizing services to promote client independence while controlling costs mattes case management a cornerstone of community-based service provision for older adults (Rife, 1992). Known by a variety of names (e.g., care management, case coordination, and service management?), case management occurs in a diverse range of long-term care programs for older adults. Although programs differ in how they implement, access, and monitor their services, they do agree on the core 315 elements of case management (Austin, 1996; Qufnn, 1993; SchraeoeP Bruno, & Dworak, 1990; Urv-Wong & McDowell, 1994).' ' ''' The case management process begins with case finding (see 16.1). The purpose of case finding is to locate individuals who ntig&ffP from services. Case managers often rely on referrals from other prpfesff^* service providers to help them in- identifying viable clients, Gatekeepers individuals who by the nature of their day-to-day work come fata t0uil contact with many people, can be trained to successfully identify Is'eMl older individuals with functional limitations and refer them to case marjs^ ment programs (Emlet & Hall, 1991). Once these individuals are. identlfiS case managers begin the intake andprescreening process by obtaining!! information about them Ce.g., presenting problem, age, income;. liy^p rangements, current level of both formal and informal service use,, and'tygf disability). Case managers also evaluate potential clients according-.trj^i gram criteria (i.e., income and level of frailty) to determine eligibility fSjp ticular services. '^'ill After a client is accepted via the prescreening, the case manager'cqnfiql the process by conducting a more comprehensive client assessinen£T£sfj$ multidimensional assessment tool (see Exhibit 16.2), the case managepgat ers in-depth information about the person's physical weU-bemgand^medic history, psychological and mental functioning, functional ability Q-.ii£|ta$| ties of daily living [ADLs] and instrumental activities of daily living [SSs social activities, formal and informal service use, economic and financial!!] tus, in-home safety, and family relationships (Krout, 1993a; Quirm;;:139.L From the assessment, the development of the care plan occurs. Thecatejalg describes the type of problem the client has and the planned outcdines^p services. The case manager operatianalizes the needs of the indivitiu^^ conjunction with a client's values and preferences to set deskei oiifeo^ goals and to design a care plan of informal and formal services to.besdrg^et,-die needs of the individual. The case manager then identifies, coordinate^ and negotiates service provision and funding. How the case manager handles the acquisition and implementation of services depends on whichcasenian^ agement model is being used (the different models will be describedlate|f^ the chapter). _ .^|&^ Monitoring Is also a function of the case manager. After arranging w.?. j|s vices, the case manager continues to periodically monitor client safefa.ctt.-u^i! ľ Exhibit 16.1 Case Management Process with the plan, the appropriateness of the plan, and the implementation of. ^ plan Ce.g., quality, timeliness, and duration). Finally, after a specified case manager conducts a reassessment of the client and care plan to . -js ^ changes in die client's needs and to evaluate the effectiveness of the cafE,B- * in meeting the client's goals. On the basis of this evaluation, the case manag ^ P If Case Finding Intake & Prescreening Comprehensive Client Assessment Development of Care Plan i Acquisition & Implementation of Services Monitoring Reassessment revises or adjusts the care plan as appropriate to reflect the client's curren needs, or the client may be discharged from the program. In die remainder of this chapter, we focus our attention on the rapidly de veloping field of case management. We begin by examining the political ir fluence and support for case management services. This section is followe by a profile of case management users and providers. We end die narrativ portion of the chapter with a discussion of the challenges facing case mar agement programs now and in the future.