Models of case management in long term home health care. The evolution of for-profit geriatric care management.

Professional geriatric care management has the potential to provide an emotionally satisfying, lucrative career for the social worker or nurse who is self-educated or who has formal continuing professional education in assessment, care options, and care coordination. Yet GCM as an organized profession, or as a career choice for the individual, requires institutional supports to grow and flourish. The GCM profession requires recognition by the states (including certification and credentialing). A network must be developed so that young persons can receive a first professional degree, or at least a concentration within nursing or social work, in the legal and financial implications of elder care as well as the biology of aging and the techniques of hands-on physical care of the elderly. Structures must be created for continuing professional education of the GCM practitioner. The various Medicaid programs that offer home care to the elderly and disabled rely heavily on assessment and case management; so does the entire Medicare system. However, the federal statutes and regulations do not explicitly authorize GCM participation in care planning. More to the point, they do not clearly authorize reimbursement of GCMs as independent professionals or as Medicare/Medicaid service providers. As private long-term care insurance evolves, GCM services should be recognized as proper components of the planning process (and therefore as services that can be reimbursed by the policy). Once this is done, the challenge for GCM professionals is to retain their focus on the needs of the elder and family, rather than to perceive themselves as gatekeepers who function to cut the cost of services instead of optimizing their variety and quality.(ABSTRACT TRUNCATED AT 250 WORDS)