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Journal of Aging and Health
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Contradictions in Case Management

Client-Centered Theory and Directive Practice with Frail Elderly

Elizabeth Clemens, DSW

The Gerontology Institute, University of Massachusetts, Boston

Terrie Wetle, PhD

Braceland Center for Mental Health and Aging, Institute of Living, Hartford

Michael Feltes, MD

Uncas on Thames Hospital, Norwich

Benjamin Crabtree, PhD

University of Nebraska Medical Center, Omaha

Deborah Dubitzky, MS, RD

Braceland Center for Mental Health and Aging, Institute of Living, Hartford

New long-term care legislation and managed care legitimate case management for gatekeeping and advocacy for frail elderly. Qualitative in-depth interviews with case managers who are social workers and nurses were used to address the question: To what extent is client-centered theory reflected in case management practice? Differences between reported client-centered theory and directive practice were identified by five themes: (a) client wishes versus system constraints; (b) the paradox of working to keep clients home versus the perceived inevitability of nursing home placement; (c) client centeredness versus the case manager's care plan; (d) client self-determination versus strategies of persuasion; (e) informing the client about case management versus the reality of practice. Ethical implications, competing demands, and environmental constraints are discussed. Suggestions are made to better integrate client-centered theory with directive practice.

Journal of Aging and Health, Vol. 6, No. 1, 70-88 (1994)
DOI: 10.1177/089826439400600105
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