Frank G. Williams

Can we Prepare Geriatric Social Workers to Collaborate in Primary Care Practices

This article reports the results of a qualitative study of the professional identities, roles, and relationships of a variety of geriatric case managers located in nine demonstration sites around the United States. Beginning with an overview of social work and nursing roles in health care settings, the authors provide background on the study and its methods, followed by results that highlight the voices of persons interviewed. They conclude with implications for social work education in five areas: articulating social works great tradition, developing career opportunities, building alliances with students and educators in other professional schools, engaging in ongoing faculty development, and infusing the social work curriculum with geriatric content.

The PhoenixCare Program

In response to a perceived need for patient access to palliative care and supportive services prior to hospice eligibility, Phoenix-based Hospice of the Valley (HOV) applied for and received a 3-year demonstration grant (1999-2001) from The Robert Wood Johnson (RWJ) Promoting Excellence in End-Of-Life Care Project. HOV established the PhoenixCare project as a demonstration of palliative and coordinated care (case management) services for seriously chronically ill individuals still undergoing active treatment of their disease within a managed care setting. The model emphasized patient/family self-empowerment and prevention. The goal was to demonstrate that it was possible to expand the scope of care for the seriously chronically ill, add palliative care, and improve patient quality of life at less (or no more) cost than that for a comparable group of managed care patients not receiving PhoenixCare services. The model proved most useful to patients willing and able to assume a degree of control over their own care. Physicians referred fewer than 5% of the patients enrolled while managed care plan case managers and hospital discharge planners referred 83%, suggesting that in organized systems of care physicians are not a primary source for patient referrals. The structure and content of the PhoenixCare model, its general acceptability to patients, physicians and managed care plans, and its applicability to other sites are discussed in this article. Outcomes from the study will be published in a subsequent paper.

Implementing a Case Management Program Designed to Enhance Primary Care Physician Practice With Older Persons

A qualitative analysis of the implementation of a case management program is presented. This collaborative research design uses semistructured interviews and observational field methods. Nested within a changing health care environment and a corporation that is restructuring, three physician practices form the intervention sites. During the course of the project there is high turnover among project staff and physicians. This analysis begins with the intervention in which case managers mobilize resources, monitor medication and health care compliance, educate elderly participants and physicians, counsel participants, and provide caregiver support and follow-up. Adjusting to and defining the case management role, structuring supervision and nurturing the intervention, and communicating (both written and face-to-face) with diverse physicians are ongoing tasks throughout project development. The importance of clear communication, the need for great flexibility, and the search to maintain project integrity (keeping sight of the intervention) emerge as critical themes.

Critical factors for successful hospital-based case management.

Six hospitals were funded to develop programs for long-term case management. Factors that should be considered when developing hospital-based case management are discussed within three areas: organizational placement, program management, and financial viability.

Geriatric case managers: integration into physician practices.

Integration of case management proved to be a key variable in a national demonstration at nine sites of alternative models designed to enhance primary care of frail elders. Numerous semistructured interviews of participants revealed a number of areas important to achieving successful integration. These areas include making favorable first impressions, building relationships, learning to collaborate, having proximity and contact, communicating, and demonstrating benefits to patients and physicians.Integration of case management proved to be a key variable in a national demonstration at nine sites of alternative models designed to enhance primary care of frail elders. Numerous semistructured interviews of participants revealed a number of areas important to achieving successful integration. These areas include making favorable first impressions, building relationships, learning to collaborate, having proximity and contact, communicating, and demonstrating benefits to patients and physicians.

Swing-Beds: The Arizona Experience

Swing-beds are acute-care hospital beds temporarily used for long-term care. A demonstration program was developed to evaluate the effectiveness of using swing-beds as catalysts for the expansion of rural hospitals into community health centers to respond better to the needs of older persons in their respective communities. We examined the background and implementation issues of the swing-bed demonstration program in six rural Arizona hospitals.

The Prospects for Prepaid Long-Term Care: The Arizona Medicaid Experiment

Arizona is adding long-term care to its prepaid, capitated alternative to Medicaid. This article discusses the potential for this major cost-control experiment. Experience suggests that those able to quality for long-term care will fare better than the poor did in the previous system. However, limiting eligibility will be the primary means of controlling costs; significant price competition is not likely to develop. The bidding process will serve more to transfer risk to contract providers than to improve program efficiency. Potential cost savings will be more than offset by an increased identification of need.

A Team-Taught Aging Policy Course

This paper discusses the development and implementation of a required course in an aging certificate program that is team-taught by social work and business faculty. A description of the course syllabus is followed by a discussion of course content. Examples provide methods of presenting current information of the interface between acute and long-term care systems, and approaches to examining financing issues in light of value and ethical dilemmas.