Driven by rising costs of healthcare and public welfare programs, insurance executives and public policy makers have found ways to impose limits on spending in health and social services through enrollment and eligibility requirements. Health care institutions and local government health and social service agencies must operate within these financial limits and to do so, they hire case managers to assess the needs of clients or patients, develop a plan of services to meet those needs, arrange and monitor delivery of services, and evaluate the effectiveness and need for continuation of services. Case management is a specialty occupation that has emerged in recent years from roots in hospital discharge planning and social work casework.
Case managers can serve as consultants for families with dependent older adults or as contracted agent representatives for a variety of agency-based supportive services. Clients often live in a different geographic area than the family member needing services, which increases their need for counseling and assistance in planning and procuring supportive services.
The flexibility of traveling to the client for delivery of service removes many of the barriers for non-ambulatory and infirm clients from accessing valuable supportive services. Medication adherence is a major factor in the elderly population. Approximately 23% of all nursing home admissions are due to patients failing to take prescription medications accurately. It is estimated that 12% of patients fail to fill their prescriptions, and of the 76% who fill their prescriptions, less than half take the full prescription (Stewart & Caranasos, 1989). With more than 32 million Americans taking more than three prescriptions daily, medication adherence is a major concern. Approximately 125,000 deaths occur annually in the United States because of non-adherence with cardiovascular medications.
Several factors can affect proper medication adherence. Changes in their mental status, such as emerging senility, changes...