Case Management for Persons in Need of Care and Frail Elderly Persons Approaches to Establish Approaching Case Management by Merging Fragmented Counseling Services

Increasing case severity, older age and partially non-existent family care networks result in the coordination of medical-care services and social support services not always contributing to an adequate care situation. In order to keep individuals in their own living and care environment whenever possible, it is necessary to provide an adjusted care mix between family care and professional care.However, the provision of care for a vulnerable group of people by both professional and informal actors requires professional coordination. The principle of case management can be used in an almost ideal way to integrate professional and informal actors in a care process and to balance both medical services and nursing and care services in the necessary setting.Stronger coordination of care services is widely recognized as a necessity. Approaches such as case management, care fees, professional hospital aftercare and community nurse approaches are being tested and implemented in various projects.The evaluation of international studies in the field of case management basically indicates a more proactive approach, with the recommendation to carry out an earlier and more specific case selection for target-oriented case management. The clear definition of inclusion criteria, the focus on patients with a high probability of readmission and intensive case management can lead to more effective care outcomes and reduced utilization of services.This paper will discuss the question of whether existing advisory services and care guide can be bundled, merged and developed into a case management organization, in particular if existing services overlap and existing resources are not sufficiently coordinated.In particular, organizational structures will be shown in which case management could be positioned in the long term. The importance of the independent care-infrastructural role of extended case management is to be stressed in this context.