Case management is proposed frequently as an all-purpose solution to the problems of access, fragmentation, unnecessary institutionalization, and excessive costs in long-term care of older persons. Case management, however, is not a particular structure or process but rather a complex arrangement of goals, client groups, agency settings, and procedures. Fifteen years of research on community-based care management fails to support most of the claims of its effectiveness in solving the problems for which it was intended. Long-term care policy, in the future, must consider a wide range of strategies including enhancing consumer decision making through disseminating information and expanding income supplements, and modifying the delivery system by encouraging more comprehensive organizations in which elders can enroll.
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