Case management in long-term care: it can be ethical and efficacious.

The present-day concept of case management combines two opposing functions, advocacy and gatekeeping, which creates an ethical tension. To maintain a balance between these activities and thus avoid untenable ethical situations, long-term-care programs must at the very least have sufficient dollars to provide required services, those dollars must be committed to the program and not subject to allocation elsewhere, and the services must be distributed fairly among those who need them. Various case management models attempt to separate the advocacy and gatekeeping functions with varying degrees of success.