title: [Care managers' perceived problems regarding case management of difficult cases and their correlates].
abstract: OBJECTIVE
  In Japan, a National Long-Term Care Insurance that provides care for older and infirm people was started in 2000 and the role of care manager (CM) was established to coordinate care plans. As a new profession, CMs have experienced difficulties. This study aimed to clarify CMs' perceived problems regarding case management of difficult cases.
  
  
  METHODS
  A nationwide mail survey was conducted with CMs in 500 public and privately run home care management organizations who were randomly sampled in 10 prefectures. A total of 556 CMs in 268 organizations returned the questionnaire, which asked questions about the demographics of CMs, their training background, employment experience, caseloads, hours worked, whether full-time or part-time, social support, and training given in the previous year. Questions about 12 different types of difficult cases, devised from a previous study by the authors were further developed in this research's preliminary interviews. The difficult cases identified included: clients with dementia, clients living alone, conflict laden families, over-demanding clients and/or family members, individuals with economic difficulties, reluctance to accept formal services, absence of a responsible family member, clients with medical needs, clients and/or family members with mental or psychological disorders, subjects of mistreatment and abuse, and those having disagreement with service providers. Bivariate analysis was conducted on the variables.
  
  
  RESULTS
  More than 40% of the CMs felt difficulties in all of the 12 case types. Among those who have taken charge of these cases within the previous year, around 80% of the CMs felt difficulties in nearly all cases. From the bivariate analysis, CMs with a registered nursing background reported less difficulty in dealing with clients with medical needs (P<.001) and clients and/or family members with mental or psychological disorders (P< .01). Paradoxically, CMs with longer experience in the job felt greater difficulty with a majority of the 12 case types. This result might be explained by the fact they are given charge of more difficult cases.
  
  
  CONCLUSIONS
  These results suggest that registered nurses have a background suitable for dealing with medical and psychological cases, while those with other backgrounds may need further training and support in these areas. Furthermore, there is a need to provide more intensive training and support to CMs with longer experience in the job who are providing care management to more difficult cases.
authors.affiliation: Department of Social Gerontology, School of Health Sciences and Nursing, Graduate School of Medicine, the University of Tokyo.
authors.forename: Satoru
authors.initials: S
authors.lastname: Yoshie
authors.forename: Tami
authors.initials: T
authors.lastname: Saito
authors.forename: Miyako
authors.initials: M
authors.lastname: Takahashi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kai
mesh_terms: D019090:Case Management; D003625:Data Collection; D004506:Education, Nursing; D006299:Health Services for the Aged; D007564:Japan; D010346:Patient Care Management