Bushy (1997) develops the need in her article for social workers being trained in case management, with special emphasis on rural case management. As she sees it, there will be an increased need for counselors in the rural setting as young people move to the cities and leave older persons behind. Since there are not as many resources found in rural settings as there are in urban settings, she suggests increase training for those who may serve in outlying areas.  Her definition of case management with relationship to counselors is interesting enough to quote here: “Case management consists of carefully coordinated and systematic referrals, whereby a counselor (as a case manager), links together services for a client.”

She states that the case manager should have the proper education and credentials, and should be responsible to coordinate care that should be tailored for the individual, they need experience and knowledge of resources, and that it is especially difficult to have the tools needed in the rural setting. One gets the sense from her article that a learning curve should first be sought in an urban practice before trying to deliver services in a rural setting.

Another important point is made by Bushy (1997) and is emphasized in her article. The rural people are more likely to see the case manager in a number of non-professional settings, such as buying groceries or going to church. This may make it more difficult for the rural case manager to avoid dualism in their practice.  It is especially important that religious overtones be kept out of the helping relationship and that the case manager refers such matters to the client/patient’s regular clergy.

Leukefeld (1990) looked at case management s a part of the structure of the social work professional. He sees case management as a way to provide needed services in an efficient manner and suggests that the cost of case management, public or private, is less that the usual savings gained by that efficiency. Even longitudinal studies, he claims, has shown at least a one year savings in costs after patients have left the hospital. Not only does he strongly suggest the use of case management in social work practices, but he further states that “Social work is on the cutting edge of case management.”

One type of case management for the older adult is Geriatric Care Management, whose history, goals, and practices will be reviewed in the following section.