Looking beyond caseload numbers for long-term home-care case managers.

Determining the best use of case managers' time is difficult both because of the great variability in the factors and the lack of outcome studies. In place of the outcome studies, the responses to focus group questions of 89 experienced case managers from across Canada were used to indicate a value for case management functions in the areas of direct care, indirect care management, and program management. The case managers identified greater value for direct care with clients and families who are new to home care or who have complex problems in comparison to clients in more stable or manageable situations. Case managers were frustrated by the lack of agency and community policies and resources to allow case managers to properly support people in their homes. The case managers valued addressing problems on a program or community basis rather than the usual case-by-case. Although preliminary, the approach could be useful in assessing the efficient and effective use of a scarce resource, case managers' time.