title: Challenges to providing end-of-life care to low-income elders with advanced chronic disease: lessons learned from a model program.
abstract: OBJECTIVE
  This study explored the challenges in providing end-of-life care to low-income elders with multiple comorbid chronic conditions in a fully "integrated" managed care program, and it highlighted essential recommendations.
  
  
  METHODS
  A case-study design was used that involved an extensive analysis of qualitative data from five focus groups with interdisciplinary team members, two in-depth interviews with administrators, and open-ended survey responses from social workers detailing death experiences of 120 elders.
  
  
  RESULTS
  Seven major themes characterized primary end-of-life care challenges: (a) the nature of advanced chronic disease; (b) the incapacity of support systems; (c) barriers to honoring care preferences; (d) challenges with characteristics and needs of participants; (e) needs of complex family systems; (f) barriers with transitions; and (g) barriers with culture and language.
  
  
  CONCLUSIONS
  The lessons learned suggest recommendations with implications for program development, practice, policy, and future research.
authors.affiliation: University of Wisconsin-Madison School of Social Work, 53706, USA. ejkramer@wisc.edu
authors.forename: Betty J
authors.initials: BJ
authors.lastname: Kramer
authors.forename: Casey
authors.initials: C
authors.lastname: Auer
mesh_terms: D000369:Aged, 80 and over; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D020380:Needs Assessment / Q000191:economics*; D010166:Palliative Care; D011203:Poverty; D015397:Program Evaluation; D036301:Qualitative Research; D012947:Social Work; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000191:economics*; D014481:United States