title: Home care users' experiences of fiscal constraints. Challenges and opportunities for case management.
abstract: With mounting fiscal constraints in home care, case managers find themselves increasingly confined in rationing roles and pressed into a narrow focus on the individual case. These pressures frustrate case management's potential to inform and contribute to more broadly-based improvements in service systems, policy formulation, and resource development. A study of home care users' perspectives in a jurisdiction where fiscal pressures have been rapidly increased reveals how rationing and service reduction affect service recipients and shape their relationships with case managers. The study sheds light on the challenges and opportunities for case managers of practicing in such straitened circumstances. Combined with their own detailed understanding of front-line service delivery, case managers can build on the knowledge of service users' perspectives to make critical contributions to both the well-being of the generally jeopardized populations who need home care and to the broadening of case management practice in keeping with its commitments to advocacy and systems level change.
authors.affiliation: School of Social Work, Kenneth Taylor Hall 319, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4M4.
authors.forename: J
authors.initials: J
authors.lastname: Aronson
authors.forename: C
authors.initials: C
authors.lastname: Sinding
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D019090:Case Management / Q000191:economics / Q000592:standards*; D003152:Community Health Nursing / Q000191:economics / Q000458:organization & administration*; D003659:Decision Making, Organizational; D005260:Female; D015276:Health Care Rationing; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D017145:Models, Educational; D009864:Ontario; D017060:Patient Satisfaction; D019037:Urban Health Services / Q000191:economics / Q000458:organization & administration*