Case management for older persons in Malta : an evaluation.

Abstract

This research is an evaluation of community case management services for older persons in Malta. The study was carried out to identify whether this innovative approach to coordinating care is enabling older persons to live longer in the community. Moreover, it identifies the service provider perspective of orchestrating managed care for this age group within a community setup. Older persons and care givers who benefit from managed care services provided by Commcare Assessment Unit participated in structured interviews facilitated by the researcher. Interviews were based on the Picker Institute Europe - Evercare Patient & Carer Questionnaires. A focus group was held with case managers to discuss their experience alongside outcome of the interviews and literature findings. A semi structured interview was performed with the administrator of Commcare Assessment Unit. Results clearly illustrate that community case management services have the potential of enabling frail older persons to live in the community. This is appreciated by older persons and caregivers, who call for innovative community services and more frequent case manager input. A number of shortcomings are experienced by Commcare Assessment Unit in realising their objectives. These include resource limitations, which are considered to be limiting the frequency of case manager contact, and fragmented community services which are considered to be short of backing managed care. Culture about hospitalisation and barriers to setting up a nurse led unit to coordinate community care are amongst problems encountered. Reports by the administrator of Co mm care Assessment Unit and enthusiasm in service delivery show that a genuine effort is employed by this unit to meet the needs of older persons and support caregivers in the community. Significant progress has been made since the unit was set up just four and a half years ago. Further achievements are possible if policy makers are sensitive to the needs of older persons and acknowledge the benefits of coordinated care for this age group.