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Developing Standards and Guidance:

There is a paucity of evidence from the literature with case load size analysis ranging in size from 15 to 100 patients per case manager and the number of annual visits ranging between 6 and 60. Local data analysis revealed a wide range of case load size among the nurse specialists for older people working in our care home support team, and comparing Nurse A and Nurse B who were case managing the lowest and highest number of patients [72 and 210 respectively] revealed the following: 

Case Management:  older people with complex needs living with frailty

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There needs to equity of case load amongst teams, both in terms of complexity of patient need and in patient numbers. This is regardless of whether the case manager works in a care home support team, community services or indeed is a practice based frailty nurse. Risk identification tools such as the Electronic Frailty Index [eFl]are good, but need to be considered within the context of what is known about the patient's needs either from past knowledge/contact/care delivery [gut feel]or through a targeted assessment. Targeted assessments can determine the need for case management considering the above approaches. More work needs to be done to explore how best to establish a workforce skilled in case managing those most vulnerable and frail. Case managing those most complex and vulnerable, that is those living with frailty, demands a workforce skilled in comprehensive assessment and care planning as well as knowledge about the syndrome of frailty. 

The challenge of frailty is the whole world is talking about it and even those most experienced in the care of older people are only just getting their heads around it