Measuring the Outcomes of Case Managed Community Care Towards a practical instrument for Australian home support

The report is the product of collaboration between Macquarie University and five organisations concerned with aged care. Three service organisations, Community Care Northern Beaches, the Benevolent Society, and KinCare and two advocacy organisations Aged and Community Care New South Wales and Community Options New South Wales have worked with A/Prof Michael Fine to develop the program of research. In 2012 funding was secured through Macquarie University's Partnership funding scheme with financial contributions from each partner organisation to develop and pilot a measure of outcomes of case management in community care.The research has been designed to test, document and apply standard measures for the determination of client outcomes in case managed community care for older people. The project, to be discussed in detail in this report, was designed to develop methodologies and collaboration to lay the foundations for future research and demonstrate the effectiveness and value of a full study.ResultsCase Manager InterviewsInterviews were conducted with 16 CMs to document the outcomes they sought to achieve with their clients. The outcomes reported included: acceptance of services; achievements or improvements in living circumstances; ability to remain safe and supported at home; independence; and 'having a life'. Examples of CM actions to achieve outcomes included regular meetings with family members, finding more suitable housing, addressing health needs, matching care workers to client's special needs, community contact, identifying tasks that clients can accomplish, linking in with services, assisting clients in their ability to choose services. CMs emphasised the importance of becoming familiar with each client's story, regularly communicating with and monitoring clients and carers wellbeing and demonstrated a person centred approach.Development and Testing of the Australian Community Outcomes Measure (ACCOM)Results of the literature review were used by the group to develop the ACCOM tool which addresses 14 outcome domains identified as significant for case managed community aged care. The tool was designed to capture goals for each domain identified as relevant to the client. The ACCOM also allowed information to be entered that took into account the health status of the client though this could be refined so that more detail could be included. One organisation completed the tool from a review of 43 case files. The other two organisations were able to indicate in a table the domains addressed in a further 45 files.The overall sample of 79 showed the most common domain, personal care was addressed in 78 pct of cases. Health was a major issue in 75 pct, home maintenance in 73 pct and mobility in 71 pct. Future planning was addressed in 18 pct of files reviewed.Overall, there was strong consistency in the number and types of domains addressed with the level of care provided by different packages. It was postulated that the number and complexity of domains could indicate an evident need for case management. Further data would be needed to establish baselines.Results showed that 69 pct of issues identified by the case manager and clients had been addressed through targeted actions, 22 pct were partially addressed and 9 pct remained to be addressed. This provides a measure of the effectiveness of case management in facilitating processes to meet client needs. This could be used to benchmark service provision.