Flexible client-driven in-home case management: An option to consider

Carol L. McWilliam, Moira Stewart, Evelyn Vingilis, Jeffrey S Hoch, Catherine Ward-Griffin, Allan Donner, Gina Browne, Peter Coyte, Karen Anderson

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Changes in health services and care needs have created high demand for case management of in-home services. To address this challenge, several models of case management have been used. Evaluations to date suggest that clients need different approaches for different circumstances at different times to optimize cost-effectiveness. Accordingly, one Canadian home care program adopted flexible client-driven case management, engaging clients as partners in flexibly selecting either an integrated team, consumer-managed or brokerage model of case management in keeping with their preferences and abilities. Using an exploratory, multimeasure quasi-experimental design, a generic model of program evaluation, and both quantitative and qualitative methods, researchers identified challenges in implementing this intervention, policy impediments the clients characteristically in each of the three case management models, and client, provider, and caregiver outcomes of flexible, client-driven care. While further longitudinal investigation is needed, findings suggest several important considerations for those interested in this option for care management. Alternative case management models do attract different client groups, and having a choice does not alter care costs or outcomes. Flexible client-driven case management may be experienced positively by case managers and other providers.

Original languageEnglish (US)
Pages (from-to)73-86
Number of pages14
JournalCare Management Journals
Issue number2
StatePublished - Jun 2005
Externally publishedYes


  • Case management models
  • Home care delivery
  • Service approaches

ASJC Scopus subject areas

  • Health Policy


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