Intensive care-management at home: an alternative to institutional

Background: care management and assessment of need are the cornerstones of the community care reforms in the UK. Although much of the research base ha s been on highly vulnerable older people, in practice, care management has been implemented for a wider group. Objective: to examine how intensive care-management at home has developed. Design: postal survey of all local authority social services departments in England. Method: we used an overview questionnaire (85% response) and an old-age ser vices questionnaire (77% response). We classified local authorities accordi ng to the presence or absence of seven indicators of intensive care managem ent at home. Results: 97% of social services departments had a goal of providing a commu nity-based alternative to residential and nursing-home care. However, only 5% had specialist intensive care-management services for older people. Othe r key indicators of intensive care-management, such as devolved budgets, he alth service care managers, small caseloads an clear eligibility criteria, were uncommon. Conclusions: there was little evidence of intensive care-management at home in older peoples' services. This is of concern, given the move towards com munity-based provision for frail older people, Closer links between seconda ry health-care services (such as geriatric medicine) and intensive care-man agement at home may promote more effective care at home for those who are m ost vulnerable.