President

1. “ensuring continuity of care through services, at any moment or
periodically (for example when the individual cyclically moves from the
institution to the community, between admissions and discharges);
2. Ensuring that the services respond to the entire range of an individual’s
needs and to their variation in time, even for a whole lifetime, if necessary” 300 ;
3. Helping people to “access the necessary services, overcoming the
obstacles linked to the access requirements, regulations, administrative
decisions, procedures;
4. Ensuring that the services (…) are carried out adequately and quickly
and do not unnecessarily overlap” 301 .
The figure of the Case Manager is present (although not always put into
action) in the National Healthcare Plan 2003-2005, as a point of reference for
the elderly who are alone, and has the task of assessing and meeting their
needs, using the network of healthcare and social-institutional services, or
friendship and solidarity networks. In a complex society like ours, there is
certainly no shortage of offer, as we have said, of social-healthcare services
and support groups, also voluntary, which can be of help to the elderly who find
themselves in difficulty; what is lacking, however, or what is at least felt to be a
primary need for this age-group, is a figure of reference, someone they can
trust. Too often, the people revolving around individuals of a certain age
overlap or multiply, which leads to a sense of insecurity and lack of care. The
figure of the Case Manager aims to meet the need of focusing on one person
the desire for a “stable relationship”, which is the foundation of a mutual human
contact. Its role is also relevant with regards to guiding the person they look
after in both understanding and decoding medical language, in organising
healthcare, from booking to undergoing the medical check-up etc., and, finally,
in their capacity to involve the patient’s family circle. To ensure this task of
involving the family members, and, more widely, friendship and solidarity
networks, we should avoid the possible risk, mentioned in critical literature, of
de-responsabilisation; the Case Manager intervenes not to take the place of
family and friendship networks (when they exist), but to increase and support
their contribution, by encouraging it and coordinating it. This role does not
intend to add another link to the chain, which is already complicated and
muddled by its bureaucratic structure; if anything, it aims to lower the incidence
of bureaucratisation and depersonalisation, accompanying the person they look
after and helping him/her extricate him/herself from the jungle of the services
offered. If this role can be a real support for National Healthcare System users
in general and for the elderly in particular, it will be of even more help, in light of
what we have said above about the condition of women in their fourth age, for
this section of the population, becoming the interpreter and guarantor of their
particular needs in the social-healthcare field.
Finally, the bioethical importance of the Case Manager cannot be
overlooked: it is aimed at individuals with high health risks, in most cases
having to face, alone, fundamental questions about end-of-life issues; the
person in this role will have to be prepared – with specific training adequate to
carrying out its different duties – also to tackle bioethically such eventual
situations: often, in fact, poly-pathologies are accompanied by a latent (or even
The implementation of individualised programs of assistance in community care (1995); P.
Donati and F. Folgherairter (ed.), Gli operatori sociali nel welfare mix, Erickson, Trento 1999.
300 B. Bortoli, Il lessico della community care, cit., p. 84.
301 Ibid.
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