Service Use and Transitions: Decisions, Choices and Care Management among an Admissions Cohort of Privately Insured Disabled Elders. F. Use of Care Management

12/01/2006

One of the goals of this study is to understand how people think of and use care managers and what influence that seems to have on their decisions, satisfaction and transitions, particularly over time. When we began designing the questionnaire for this study, we interviewed key senior management personnel from each of the participating insurance companies to better understand how they define care management, who provides it and who receives it.8 We had a series of standard questions that we asked each company to determine their care management philosophy and program. The questions included:

  1. Do you provide care management?

  2. What is your definition of care management/what does it consist of?

  3. What is the goal or corporate philosophy of care management?

  4. To whom do you provide care management?

  5. Do you provide incentives for the use of care management?

  6. Do you have your own care managers or do you use a third party vendor?

  7. Do you provide training your care managers or to the care managers you use?

  8. Do your care managers or the care managers you use need to meet specific requirements before they become care managers?

  9. Do you provide in person or telephonic care management?

  10. Are the care managers familiar with the benefits available to the clients under their LTC insurance policies?

One of the most important things that we learned from this exercise is that each company defines care management a little differently. According to the responses we received, there was a great deal of variation surrounding the definition of care management services. According to the insurers participating in this study, care management might range anywhere from claim adjudication and assessment, to the full gamut of services including assessment of needs, care plan development and implementation, coordination of services, and reassessment.

The information we received helped to inform the development of questions related to the use of a care manager and the services they provide. Based upon what we learned from our discussions with the insurance companies, we defined a “care manager” broadly so we could be assured of capturing the different models in operation at the time of the study. We instructed the nurse assessors to read the following:

Sometimes when people need to find paid care and make arrangements for care, they work with a person called a care manager or care coordinator. This person is generally a nurse or health professional and is either someone you can hire privately or someone your LTC insurance company provides to you. He or she may visit with you in your home or talk to you over the telephone. This person is different from a doctor or a hospital discharge planner.

It appears that only a small percentage of participants (regardless of service setting) used a care manager. Figure 31 shows that the use of a care manager is higher among people in the community than in facilities, which is what would be expected; however, it is still only 19% for paid home care recipients. All the information that follows regarding specific services and satisfaction are based only on those who used a care manager.

FIGURE 31: Use of Care Manager by Service Setting

Even though most insurance companies provided some aspect of care management services to their insured’s (mostly upon the request of the insured), we were interested in knowing if those who were using a care manager hired them privately or used the insurance company’s care manager (see Figure 32). Surprisingly, a high proportion of those who have a care manager hired them privately, particularly those using paid care in ALFs (although these results should be viewed with caution given the small sample size for both nursing home and ALF residents).

Most of the nursing home residents that have a care manager used one provided by the insurance company, while paid home care recipients were approximately evenly divided between privately hired and insurance company provided care managers. Almost all of those not yet receiving paid care obtained their care manager from the insurance company. This is not surprising given that most of them have not made arrangements for care and are less sure of their future plans.

FIGURE 32: For those Receiving Care Management, who Provided the Service

We also wanted to know what types of services the care managers provided and if they differed by service setting. As shown in Figure 33, care managers for those residing in nursing homes were more likely to help with the development of a care plan and where to get care, and are less likely to have helped the insured find local providers. Coupled with the fact that such a small number of nursing home residents used a care manager, it is likely that they had less choice about where to receive care and less choice of local providers.

FIGURE 33: Duties Performed by Care Manager by Care Setting

We also asked if the care manager’s service recommendations were followed and in almost all cases they were. All of the home care recipients and ALF residents indicated that they followed the care manager’s recommendations, while 94% of nursing home residents stated the same. For those in residential care settings, we wanted to know if the care manager specifically recommended care in their current service setting. Approximately 60% of nursing home residents stated that their care manager made a recommendation for care in a nursing home and 92% of ALF residents said the same. Satisfaction with the services provided by the care manager was very high (95% or higher) across all service settings. All of those who used a care manager felt they were helpful, that they listened to concerns that were raised, they were responsive to the claimant’s needs and they spent enough time helping the claimant and/or their family.

Although there were some variations across service setting for use and satisfaction of care management, for the most part those who used care managers were satisfied with their services.

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