Dementia-oriented case management for home-dwelling people with dementia and their family caregivers

PURPOSE: To describe the activities and time spent by casemanagers for home-dwelling people with dementia and their family caregivers in a western region of the Netherlands. THEORY: People with dementia and their family caregivers go through several transitions in disease, care and social roles. Integrated care for this group is important. In the Dutch Guideline for Integrated Dementia Care (2008), the casemanager is put forward as the vital link in the health-care supply chain for demented people and their families. METHODS: During six months, six casemanagers registered the frequency and content of their contacts with a total of 40 home-dwelling elderly and their families. RESULTS AND CONCLUSIONS: On average, casemanagers had contact with their clients once every five weeks, mostly with the family caregiver alone (by phone) or with the client-caregiver dyad (home visit). The mean contact time was about 50 minutes. The most frequent interventions offered by the casemanager are: monitoring (keeping track), listening, and giving moral support, practical advice and information about services and procedures. Casemanagers spend most of their working time linking health care services with the client-caregiver's needs. They spend about 5–6 hours per month at non-client related activities, including education/studying, participation in dementia support groups and networking. DISCUSSION: Case management includes monitoring, counselling and linking of care to stimulate tailor-made care that meets the needs of the client-caregiver dyad. A caseload of around 50 clients per FTE casemanager seems reasonable.