Care management – the heart of integrated care
In policies concerning integrated care for the disabled
elderly, care management has become an important
topic for consideration. Standardised care, continuity
of care, flexibility of care, and finely tuned co-ordination
between the different kinds of care providers are
a central part of care management in order to realise
high quality care for the disabled aged and to enable
them to continue to live independently in their own
homes for as long as possible. This is the most
important reason that the Japanese LTCI scheme has
formalised the care management process. A care
manager is entrusted with the entire responsibility of
planning all care and services for individual clients.
According to the results of a needs assessment of the
client and his or her wish, a care plan is drawn up.
The care manager organises the care specified in the
care plan and works with the client, supervises and
evaluates the care process (monitoring). When necessary,
the care plan is adjusted. In this way the care
manager plays a pivotal role in the LTCI scheme. The
LTCI scheme pays a fee of care management for
each care manager