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Factors That Influence Home Care Case Managers' Work and Workload

Fraser, Kimberly PhD; Baird, Lisa Garland PhD; Laing, Daley MA; Lai, Jonathan MSC; Punjani, Neelam Saleem MScN

doi: 10.1097/NCM.0000000000000320

Background: Home care services are increasing across Canada and in other developed nations. There has been increased pressure on home care programs to not only accept more clients more rapidly but also work more efficiently. Case management is an approach through which clients access and receive home care. With both rising numbers of clients and growing complexity among them, case managers' work and workload are also increasing. The demands on case managers and expansion in caseloads are happening without an increase in resources or funding. With case manager work increasing steadily, an understanding of the factors that influence their work and workload is vital.

Purpose: The purpose of this study was to explore what factors influence case managers' work and workload.

Methods: This study used an ethnographic approach. It took place in Alberta, Canada, in 3 home care offices in urban and suburban geographic areas. Purposive sampling was used, and participants included 28 home care case managers with predominantly long-term clients (>3 months on home care), 3 site managers, and 1 project lead. Data collection methods included semistructured interviews, nonparticipant observation, participant journaling, and focus groups.

Results: Case manager works were portrayed in 2 key ways: the number and type of tasks a case manager was required to complete and the amount of time and energy needed to complete a task. The factors that influence case manager work and workload fall into 3 overarching categories: structural, operational, or individual factors.

Discussion: The 3 overarching categories, as well as interactions between various factors, contribute to what is known about case managers' work and workload. Participants found it difficult to discuss the factors in isolation because the interaction and “messiness” of the factors were inherent in their actions and stories about their work and workload. Workload includes not only the easily captured work such as direct care and specific activities such as assessment but also diverse forms of invisible work such as problem solving, rapport building, and caseload management, as well as emotional work such as coping, stress management, and team support.

Implications for Case ManagementCase managers' work and workload in home care are important phenomena. In a climate of budgetary restraint and an aging population, which seemingly prefer home care as much as the system desires to provide it as a main option for care, it is important to capture, recognize, and legitimize an understanding of case managers' work and workload. Increased knowledge in this area could, in turn, transforms both home care and case management.

Kimberly Fraser, PhD, is Associate Professor, University of Alberta, Edmonton, Alberta, Canada.

Lisa Garland Baird, PhD, University of Alberta, Edmonton, Alberta, Canada.

Daley Laing, MA, is Research Assistant, University of Alberta, Edmonton, Alberta, Canada.

Jonathan Lai, MSc, is Research Assistant, University of Alberta, Edmonton, Alberta, Canada.

Neelam Saleem Punjani, MScN, is Research Assistant, University of Alberta, Edmonton, Alberta, Canada.

Address correspondence to Neelam Saleem Punjani, MScN, University of Alberta, 76 Ave NW, Edmonton, AB T6E 1L4, Canada (

The authors report no conflicts of interest.

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