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Case management, in various forms, is now institutionalized as a core part of policy and programs designed to deliver home- and community-based services to older adults. The case management role, in theory, requires attention to both client and system goals, although in practice the system goals that have received most attention have been gatekeeping and resource allocation. While case managers have been admonished to find and develop resources in the community, this has primarily taken the form of including informal services in individual client care plans. What has been missing is focused attention to the potential of the community as a nurturing environment with the capacity to support older adults and their caregivers. Sustainable care for older adults cannot be achieved by formal service and family support alone. This article proposes the creation of linkages between case managers, who build the service arrangements for older people, and community developers, who are responsible for building community capacity and social capital. It is argued that this linkage is essential for establishing the foundations of a caring community with the capacity to support older people.

Even after 30 years of experience, two questions persist about case management practice. Who needs it and does it work? Answers to these questions are neither direct nor simple. This article examines the significance of various contexts (policy, system, community, and organization) to efforts attempting to provide responses to these basic questions. Beyond the question of who needs case management, two additional questions are addressed. Who needs it and who gets it? Clients' qualitative perspectives on case management effectiveness, beyond attempts to measure satisfaction and quality of life, are usually absent. The article concludes with a discussion of whether these are the right questions.

One way to examine how case management has become a favored tool of public policy is to explore how it has evolved in various human service settings. This article compares, describes, and analyzes case management in six program categories: (a) for persons suffering from chronic mental illness; (b) in child welfare; (c) in community-based long-term care; (d) for children and adolescents suffering from severe emotional disturbance; (e) for individuals experiencing substance abuse problems; and (f) in the public welfare system. Case management in these settings is compared along three dimensions: legislative ad programatic origins; models; and outcome measures. The analysis reveals the extent to which case management has become a cornerstone of public policy--characterized by cost containment accomplished through substantial and continuing reduction in public support for human service programs.

Care Planning is one of the most important responsibilities of the case manager in home care. Research on how care plan decisions are made is scarce in the case management literature. The purpose of this exploratory study was to determine the factors that influence the decision-making process of case managers within the Edmonton Home Care Program (EHCP) when developing care plans. A volunteer sample of six EHCP case managers from three different disciplines was selected: two registered nurses (BScN), two occupational therapists (BScoT), and two social workers (BSW). With the use of fictional case studies, these professionals were asked to construct care plans. Individual semi-structured interviews and a group session permitted in-depth exploration of their decision-making process. Findings suggest that client and/or caregiver characteristics appear to be the most influential in determining care plans. It was also found that case managers are not comfortable with fiscal accountability.