Challenges in End-of-Life Care Management for Low-Income Frail Elders: A Case Study of the Wisconsin Family Care Program

The need for well-coordinated care at the end of life is an important priority for meeting the needs of the growing number of low-income frail elders who are advancing in age. Partially integrated (Medicaid only) models of managed long-term care (MMLTC) are viewed as one promising and financially vi...

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Bibliographic Details
Published in:Research on aging 2013-07, Vol.35 (4), p.393-419
Main Authors: Kwak, Jung, Kramer, Betty J., Lang, Josh, Ledger, Maria
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Care of the aged
Communication
Coordination
Decision making
Disabled persons
Elderly
Grief
Handicapped
Interpersonal communication
Long Term Care
Low Income Groups
Management
Medical sciences
Miscellaneous
Older people
Palliative care
Policy Making
Public health. Hygiene
Public health. Hygiene-occupational medicine
U.S.A
Wisconsin
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Summary:The need for well-coordinated care at the end of life is an important priority for meeting the needs of the growing number of low-income frail elders who are advancing in age. Partially integrated (Medicaid only) models of managed long-term care (MMLTC) are viewed as one promising and financially viable approach to enhance care coordination, yet we know little about the challenges that care managers face in managing the end-of-life care needs of poor elders. A case study design was used to explore challenges encountered in the provision of end-of-life care management for low-income elders enrolled in an innovative partially integrated model of long-term care, in Wisconsin, the Milwaukee County Family Care program. Data were collected via in-depth interviews with county administrators (n = 4) and selected lead supervisors or care managers (n = 7) and two focus groups with care management team members (n = 17). We identified five major themes representing essential challenges: (1) complexity of care and high level of support needs; (2) communication constraints in advance care planning; (3) family conflicts in end-of-life decision making for elders; (4) insufficient communication and collaboration between elders, families, teams, and service providers; and (5) limited bereavement and grief related support for families and teams after elders die. We discuss similarities and difference in the challenges reported here as compared to challenges reported in studies of other models of care and offer recommendations for program and policy development.
ISSN:0164-0275
1552-7573
DOI:10.1177/0164027512446939