Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 54, Issue 2 S109-S119, Copyright © 1999 by The Gerontological Society of America
Adding values: an experiment in systematic attention to values and preferences of community long-term care clients
RA Kane, HB Degenholtz and RL Kane
Department of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, USA. [email protected]
OBJECTIVES: We tested the effects of providing case managers with tools to
assess and respond to client values and preferences on their subsequent
knowledge of clients' values and their practices in arranging long-term
care. METHOD: Using a quasi-experimental design with newly enrolled,
cognitively intact clients, we compared case managers, clients, and care
plans at the experimental and control agency. RESULTS: Three weeks after
enrollment, experimental clients were significantly more likely to report
that case managers had asked them about their own preferences and offered
them choices about services. Actual client values reported at the 3-month
follow-up were similar for the two groups, with experimental case managers
only slightly more accurate judges of their clients' responses to values
questions. At follow-up, experimental case managers reported more case
activity tailoring plans to client preferences, a finding confirmed by
record reviews. Client acuity, measured by ADL functioning and prior
hospital use, was associated with less perceived discussion of client
preferences during the initial care planning process, but more case
activity related to client preferences during the first three months.
DISCUSSION: The study suggests it is possible to sensitize case managers to
the importance of assessing and acting on client values. Getting them to do
so consistently, however, may require changes in the practice environment.
