title: The case for integrating behavior change, client-centered practice and other evidence-based models into geriatric care management.
abstract: This paper describes the complexities of engaging a frail, elderly population in the process of behavior change to improve daily functioning. Implementation of a brief Purchase of Services (POS) benefit supplementing usual geriatric care management in an integrated, not-for-profit HMO environment is used to illustrate these complexities. Findings from the first two years of the four-year study of the intervention showed that one-third of the group of 541 study participants who were randomized as eligible to participate refused these free, enhanced services. The reasons for these refusals are examined, and a case is made for incorporating behavior change theory into traditional geriatric care management practice for cognitively intact clients in order to facilitate acceptance of needed services and increased patient autonomy.
authors.affiliation: Geriatrics and Continuing Care, Tri-Central Kaiser Permanente, Los Angeles, CA, USA. lynn.x.hackstaff@kp.org
authors.forename: Lynn
authors.initials: L
authors.lastname: Hackstaff
authors.forename: Carol
authors.initials: C
authors.lastname: Davis
authors.forename: Lynne
authors.initials: L
authors.lastname: Katz
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001521:Behavior Therapy; D019090:Case Management; D003625:Data Collection; D019317:Evidence-Based Medicine; D005260:Female; D006279:Health Maintenance Organizations; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D017146:Models, Organizational; D018802:Patient-Centered Care; D015143:Philadelphia