Abstract

Community-based geriatric case managers work with an increasingly frail older population in need of advance care planning (ACP) throughout the end of life; however little is known regarding factors that influence their professional practices in this area. This study presents the findings from a mixed methods study which utilized focus groups and surveys to examine case managers' ACP practices in the state of Florida in the United States. Qualitative findings suggest that case managers hold ambiguous views regarding ACP, perceive divergent roles in this area, and engage in a range of primarily informational ACP practices. Themes from the study suggest that case managers view five key influences that either assist or impede practices including: (1) paradox of case management and programmatic realities; (2) extent of family presence and involvement; (3) level of proficiency in ACP; (4) degree of client receptivity to planning; and (5) limited communication with providers. Regression analyses of the state-wide surveys suggest the following correlates of practice: years of experience, the amount of ACP training experiences, perceived skill in geriatric practice competencies, perceived barriers to practice, and experience in ACP of a personal nature. The research reveals that community-based practitioners engage in a broader approach to ACP which extends beyond domains of health and end-of-life care by addressing social, legal, financial and residential planning as well. In addition, the study's findings empirically support a conceptual model of factors associated with professional practice.