title: Intensive care-management at home: an alternative to institutional care?
abstract: BACKGROUND
  Care management and assessment of need are the cornerstones of the community care reforms in the UK. Although much of the research base has 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.
  
  
  METHODS
  Postal survey of all local authority social services departments in England.
  
  
  METHODS
  We used an overview questionnaire (85% response) and an old-age services questionnaire (77% response). We classified local authorities according to the presence or absence of seven indicators of intensive care management at home.
  
  
  RESULTS
  97% of social services departments had a goal of providing a community-based alternative to residential and nursing-home care. However, only 5% had specialist intensive care-management services for older people. Other key indicators of intensive care-management, such as devolved budgets, health service care managers, small caseloads and 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 community-based provision for frail older people. Closer links between secondary health-care services (such as geriatric medicine) and intensive care-management at home may promote more effective care at home for those who are most vulnerable.
authors.affiliation: Personal Social Services Research Unit, Dover Street Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK. D.J.Challis@man.ac.uk
authors.forename: D
authors.initials: D
authors.lastname: Challis
authors.forename: R
authors.initials: R
authors.lastname: Darton
authors.forename: J
authors.initials: J
authors.lastname: Hughes
authors.forename: K
authors.initials: K
authors.lastname: Stewart
authors.forename: K
authors.initials: K
authors.lastname: Weiner
mesh_terms: D000368:Aged; D003422:Critical Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization; D010346:Patient Care Management / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D000078329:Workforce