Can case management be an asset to home care interventions in order to delay institutionalization of frail older persons? A Belgian longitudinal study.

Background / Objective: In the international literature, case management is often found to be a valuable way of organizing home care services and providing continuity of care. However, not many studies have provided evidence that case management can be effective in delaying institutionalization of older persons. The Belgian federal government is interested in funding home care projects that attain this goal. Twenty two case management projects will be analyzed during a 4-year period to reach a policy decision. Methods: Professional caregivers are asked to fill out the comprehensive geriatric assessment interRAI Home Care (HC) and an ad-hoc economic questionnaire describing the social services use and the time of informal care Informal caregivers also fill out the Zarit Burden scale 12 items and older persons fill out the WHOQOL-8. After descriptive statistics, the study population is stratified according to impairment levels (ADL, depression and cognition). Multivariate analyses are performed to identify significant associations and the effect of case management on the delay of institutionalization. Results: The study population consists of frail older persons in 21 case management projects (n=8534, average age: 79.7 median age 81.0, 67.6% women. The total of older persons in case management projects is 5004. This population shows moderate to high ADL impairment (47% CI(0.45 - 0.48)), moderate to high cognitive problems (27% CI(0.25 - 0.27)) and daily depression symptoms (27% CI(.25 - .28). These clients will be compared to a population not receiving any case management. Conclusion: This research will show the effect of case management combined with home care interventions in order to delay institutionalization of older persons. This information can help home care providers to adapt their services into a more integrated form of care model where case management will bring different types of services together. The results will also help policy makers to decide whether case management should be funded or not. [ABSTRACT FROM AUTHOR]