Case management issues in rural long-term care models

This article reviews research on some of the more visible long-term care case-management systems. In particular, the two generations of the Social Health Maintenance Organization (SHMO) and Program of All-Inclusive Care for the Elderly (PACE) models are described, and alternative state-level models are also examined. The potential applicability of these models to rural settings is explored. Some elements of the SHMO and PACE programs that rely heavily on a well-developed provider infrastructure may not be applicable to rural settings. However, the models share some components that are directly applicable to rural settings, including integration of social, community-based, and medical services. The article concludes with a case study from a rural case-management model in Illinois that has evolved over time and with various rural populations.