Adding values: An experiment in systematic attention to values and preferences of community long-term care clients

Objectives. We tested the effects of providing case managers with tools to assess and respond to client values and preferences on their subsequent kno wledge of clients' values and their practices in arranging long-term care. Method Using a quasi-experimental design with newly enrolled, cognitively i ntact clients, we compared case managers, clients, and care plans at the ex perimental and control agency. Results. Three weeks after enrollment, experimental clients were significan tly more likely to report that case managers had asked them about their own preferences and offered them choices about services. Actual client values reported at the 3-month follow-up were similar for the two groups, with exp erimental case managers only slightly more accurate judges of their clients ' responses to values questions. At follow-up, experimental case managers r eported more case activity tailoring plans to client preferences, a finding confirmed by record reviews. Client acuity, measured by ADL functioning an d prior hospital use, was associated with less perceived discussion of clie nt preferences during the initial care planning process, but more case acti vity related to client preferences during the first three months. Discussion. The study suggests it is possible to sensitize case managers to the importance of assessing and acting on client values. Getting them to d o so consistently, however, may require changes in the practice environment .