When care coordination is needed

CA-15

 

A care coordination (or ‘case management’) model of care has been found to be important for clients with multiple or complex care needs, especially when patients are using more than one service.

Coordinated care provides a single point of contact through a coordinator (or ‘case manager’) that coordinates a multi-disciplinary team and a range of services and providers (e.g. nurses, doctors, allied health professionals, volunteers and home support workers) involved in the care and support of the client and their family.

  • Care Coordination (or ‘case management’): “a collaborative process of assessing, planning, organisation and facilitation of options and services that meet a person’s health and wellbeing needs through communication and maximising available resources to achieve quality and cost-effective service outcomes.”

The benefits of care coordination are particularly important for clients with a combination of multiple and/or complex needs, including:

  • limitations in cognitive, perceptual or social functioning
  • behavioural, emotional or mental health issues
  • lack of an informal support network
  • carers who need support
  • social or geographic isolation
  • clients whose level of physical frailty or vulnerability impacts on their ability to organise their own care or advocate on their own behalf,
  • involvement of multiple services,
  • coming from diverse cultural or linguistic backgrounds, or
  • at high risk of inappropriate admission into hospital or residential care.

The benefits of care coordination

A care coordination (or ‘case management’) model of care has many benefits to consumers, including:

  • consumers are supported to access the system more easily,
  • more optimal use is made of available resources by better identifying the most appropriate type and level of service and/or support for the individual’s specific needs,
  • independence and confidence of consumers is better supported and provided including in the area of physical and psycho-physical ability,
  • alternatives to residential care are more effectively achieved,
  • service innovation is more often the by-product of intensely tailored community services, and
  • reliance on and use of health services is reduced substantially.

Care-Coordination-system