Community matron caseload numbers: a literature review

Factors That Influence Home Care Case Managers' Work and Workload

BACKGROUND

Home care services are increasing across Canada and in other developed nations. There has been increased pressure on home care programs to not only accept more clients more rapidly but also work more efficiently. Case management is an approach through which clients access and receive home care. With both rising numbers of clients and growing complexity among them, case managers' work and workload are also increasing. The demands on case managers and expansion in caseloads are happening without an increase in resources or funding. With case manager work increasing steadily, an understanding of the factors that influence their work and workload is vital.

PURPOSE

The purpose of this study was to explore what factors influence case managers' work and workload.

METHODS

This study used an ethnographic approach. It took place in Alberta, Canada, in 3 home care offices in urban and suburban geographic areas. Purposive sampling was used, and participants included 28 home care case managers with predominantly long-term clients (>3 months on home care), 3 site managers, and 1 project lead. Data collection methods included semistructured interviews, nonparticipant observation, participant journaling, and focus groups.

RESULTS

Case manager works were portrayed in 2 key ways: the number and type of tasks a case manager was required to complete and the amount of time and energy needed to complete a task. The factors that influence case manager work and workload fall into 3 overarching categories: structural, operational, or individual factors.

DISCUSSION

The 3 overarching categories, as well as interactions between various factors, contribute to what is known about case managers' work and workload. Participants found it difficult to discuss the factors in isolation because the interaction and "messiness" of the factors were inherent in their actions and stories about their work and workload. Workload includes not only the easily captured work such as direct care and specific activities such as assessment but also diverse forms of invisible work such as problem solving, rapport building, and caseload management, as well as emotional work such as coping, stress management, and team support.

IMPLICATIONS FOR CASE MANAGEMENT

Case managers' work and workload in home care are important phenomena. In a climate of budgetary restraint and an aging population, which seemingly prefer home care as much as the system desires to provide it as a main option for care, it is important to capture, recognize, and legitimize an understanding of case managers' work and workload. Increased knowledge in this area could, in turn, transforms both home care and case management.

Measuring Home Care Caseloads

In response to caseloads that are increasing in numbers and acuity, Alberta Health Services developed the Caseload Intensity Tool (CIT). The development and testing process led to a valid and reliable tool that connects client clinical condition to clinician response. The CIT allows clinicians to discriminate between levels of client intensity quickly and accurately. The scores for each client are summarized first into a client intensity scale and then a caseload intensity scale. The CIT can facilitate caseload management including matching client needs to resources and improving staff resource management, for example, equitable caseloads. There is potential for the tool to validate the relatively invisible work of case managers making it understandable, measurable, and defensible during times of rising costs and budget restraint.

[Case management and complex chronic diseases: concepts, models, evidence and uncertainties]

Chronic diseases are the greatest challenge for Health Care, but the conventional health care models have failed noticeably. Nurses are one of the main providers of the services developed to tackle this challenge, with special emphasis on case management, as one of the most common forms. But, one of the key problems is that case management is poorly conceptualized, and with the diversity of experience available, make its development and comparative evaluation difficult. An in-depth review on case management definition and concepts is presented in this article, with a description of the models, ingredients and the effectiveness reported in various studies. The remaining uncertainties in case management, such as the heterogeneity of designs and target populations, the weak description of the components, and the scarce use of research models for complex interventions, are also discussed. Finally, some key factors for a successful implementation of case management are detailed, such as a clear definition of accountability and roles, the existence of support to guarantee the competence of case managers, the use of valid mechanisms for case finding, adjusted caseload, accessible and team-shared record systems, or the integration of health and social services.