Case manager-defined roles in the Medicare Alzheimer's Disease Demonstration: relationship to client and caregiver outcomes.

This study explores the different approaches to case management within, the Medicare Alzheimer's Disease Demonstration. Eight sites from around the country were selected to participate in a survey of case managers (N = 57) that evaluated their professional background and experience and how certain tasks, functions, and goals of case management were prioritized at each site. Client and caregiver outcomes were collected on a site-by-site basis as part of the demonstration. The hypothesis was that the way in which case managers performed their work would vary by site. Furthermore it was hypothesized that these differences would be measurable and correlated with project outcomes. Case managers differed significantly by site in how they prioritized tasks, functions, and goals, viewing themselves along a continuum from a clinical approach to one that emphasizes service management. These differences in case management style are reflected in between-site differences in certain client and caregiver outcomes but not others. Specifically, variations in case management style are not related to client cognitive or functional status but to other outcomes including behavioral management, caregiver burden, and service use.