After briefly reviewing the goals of long-term care, the goals of case management, and the models in which they currently function, this article focuses on the importance of recognizing the differences in culture, values, ideology, and policies in which case management takes place and the main issues confronting case managers. These issues can be divided into two broad categories: (a) policies that have serious implications for case management but over which case managers have little or no individual control; and (b) those in which case managers are directly involved, partly because of the context in which they work and partly because of the case management function itself. The issues must be addressed so that case managers individually and collectively can do the best possible job in serving vulnerable subpopulations in need of long-term care.