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Soc Work Health Care. 2004;38(3):1-19.

The case for integrating behavior change, client-centered practice and other evidence-based models into geriatric care management.

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Geriatrics and Continuing Care, Tri-Central Kaiser Permanente, Los Angeles, CA, USA.


This paper describes the complexities of engaging a frail, elderly population in the process of behavior change to improve daily functioning. Implementation of a brief Purchase of Services (POS) benefit supplementing usual geriatric care management in an integrated, not-for-profit HMO environment is used to illustrate these complexities. Findings from the first two years of the four-year study of the intervention showed that one-third of the group of 541 study participants who were randomized as eligible to participate refused these free, enhanced services. The reasons for these refusals are examined, and a case is made for incorporating behavior change theory into traditional geriatric care management practice for cognitively intact clients in order to facilitate acceptance of needed services and increased patient autonomy.

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