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 fhe place to start to look For information about housing policy or programs. Visitors con 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. HomeSlore.com: Senior Living www.springstreetcom/seniors/index.jhiml?source=a UnHjf597 This Web site displays buildings, grounds and interiors of retirement communities, assisted living facilities and nursing homes in color photographs. Detailed information on each property may also be found, as well as names of moving companies, self-slorage, financing, and retirement planning books. Mature Market Resource Center wvvw.seniorprogroms.corn The Mature Market Resource Center has two Web-based organizations. First, the Association 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 af Senior Health Professionals is a Web-based membership organization specifically designed to address fhe unique needs and special interests af professionals in the rapidly growing field of senior health. Assisted Living Federation of America (ALFA) www.olfa.org ALFA'5 Web sile provides information to consumers, including a sample resident agreement, videotapes la help consumers and families ease the transition lo senior housing, and a directory of ALFA members. Case Management Ruby, 86, suffers from Parkinson s disease. Widowed for 5 years, Ruby lives in a small house one block from fhe 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 7Ö7ear-old sister-in-law who lives 5 miles away, and two nieces who are caring and attentive bul live out of state. To 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 fhe use of the senior bus for visits to the doctor when her neighbors are not available to take 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 seeking 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 dieir 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 makes 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; Quinn, 1993; Schraed 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 might ben' from services. Case managers often rely on referrals from other professio service providers to help them in. identifying viable clients. Gatekeepers 1 individuals who by the nature of their day-to-day work come into' routjj contact with many people, can be trained to successfully identify isolate older individuals with functional limitations and refer them to case mana ment programs (Emlet & Hall, 1991). Once these individuals are idenMg case managers begin the intake andprescreening process by obtaining Bail information about them (e.g., presenting problem, age, Income- llvifijp rangements, current level of both formal and informal service use, and'type! disability). Case managers also evaluate potential clients according td;-pr gram criteria (i.e., income and level of frailty) to determine eligibility facp' ticular services. After a client is accepted via the prescreening, the case managercontinti the process by conducting a more comprehensive client assessment TJsin| multidimensional assessment tool (see Exhibit 16.2), the case manager gat ers in-depth information about the person's physical weU-being:andimedTc history, psychological and mental functioning, functional ability (he's act£ ties of daily living [ADLs] and instrumental activities of daily living UMSIs social activities, formal and informal service use, economic and financial*^ tus, in-home safety, and family relationships (Krout, 1993a; Quinn-;: :i99i From the assessment, the development of the care plan occurs. Thecareoli describes the type of problem the client has and the planned outcomes, pflt services. The case manager operationalizes the needs of the individual conjunction with a client's values and preferences to set desired outcor goals and to design a care plan of informal and formal services tohestme die needs of the individual. The case manager then identifies, coardlnaa and negotiates service provision and funding. How the case manager banal ^ the acquisition and implementation of services depends on which casemar^^ agement model is being used (the different models will be describedUaterftj die chapter). .,1 Monitoring is also a function of the case manager. After arranging mr ^ vices, the case manager continues to periodically monitor client sarisfac % Exhibit 16.} Case Managemenf Process with the plan, the appropriateness of the plan, and the implementation or s| (e.g., quality, timeliness, and duration). Finally, after a specified mm^^ manager conducts a reassessment of the client and care plan to ■ ..,-e,i case changes in the client's needs and to evaluate the effectiveness of the care Bj*^ in meeting the client's goals. On the basis of this evaluation, the case mina ^ Case Finding 1 Intake & Prescreening Comprehensive Client Assessment Development of Care Plan 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 mai agement programs now and in the future.