Case Management is a discipline within the Long Term Care system. Case managers help and give guidance in the planning process of developing a care plan for individuals with different diagnoses. The case manager assesses an individual, plans the care, facilitates communication between all members of the team, coordinates appropriate care, evaluates the individual, and acts as an advocate for proper communication between the patient, family members, and the interdisciplinary team (Marion et al., 2010). Case managers are individuals who have specialized in a field within the human and health services, receiving higher education, a license or certification. This education allows case managers to be able to perform assessments on their own, within …show more content…
the discipline. Further, case managers must have had experience within the case management, health or behavioral health field. Those individuals that receive care from the interdisciplinary team are clients who need case management services, due to their disability or illness. An individual can get a referral from their doctor working for the payer’s organization, to use a case manager (Tahan et al., 2012). The case manager’s main role is to assess and manage proper, efficient care for these individuals while being cost-effective for the system. Case managers can be broken up into two categories: external and internal case managers. External case managers are employed by the payers of the system, such as managed care organizations (Pratt, 2010). The payers allow the external case managers to control procedures, which are too expensive, limiting high priced expenses that are unnecessary. The providers, optimizing the patient’s outcomes while being priced at the lowest rate, employ internal case managers. The internal case managers are more involved within the interdisciplinary team in creating and managing the client’s care. The internal case manager makes sure all members of the care team are able to communicate properly with one another, being the link of the team. The case manager manages use of resources to provide the most efficient care for their clients, which can possibly lead to the client being able to care for himself/herself. They focus on good transitions of care, reducing the fragmentations of care within the system. Further, the case manager’s main goal is to improve the safety, satisfaction, outcome of their clients, and to move their client into the optimal levels of health possible (SITE). The core steps of case management are: identifying and selecting clients, identifying problems/opportunities and making an assessment, developing the care plan, implementation of the care activities, evaluation of the case management plan, and termination of the case management process (Marion et al., 2010). All the steps allow for an organized process to occur when evaluating a patient and creating a proper, specific care plan for them. The case managers use evidence based guidelines to create their observations and assessment on the plan of care (SITE). Identifying a client, allows for the case manager and interdisciplinary team to select clients who will benefit from the usage of a care manager. The case manager screens the individual of past and present health related issues, their insurance coverage, their home situation, and more relating to how they live their daily life. The identifying/screening phase allows for the identification of the main problems that need to be addressed for the individual. This is useful in properly recognizing the health concerns that the individual has, resulting in proper care being given. This prevents unnecessary care to be given to the individual, making the process cost effective, benefiting the long-term care system and the individual getting the care. The following step is to create an assessment on the individual. This occurs whenever it is needed throughout the case. With the identification of problems and opportunities, the individual can gets assessed and later reassessed. This benefits the individual because with each reassessment, new care plans can get created to further help the individual with proper treatment. With the assessment, the case manager further identifies the problems that need to be addressed, and the needs and interest of the client. With this information the proper plan of care will be put into place. With the assessment, the case manager can determine which provider/providers of long-term care will be used for the individuals care plan. After the assessment, the development of the planning process occurs. An objective of the individual is reached, resulting in a plan of care to cater to that objective for the client. The care plan envisions the goals and actions that they would like the client and the interdisciplinary team to reach. The plan of action is specified within a time frame to be reached, and are realistic and achievable goals for the client (Tahan et al., 2012). Once the payer authorizes the plan of care and the resources are identified, the plan begins. This process is organized and is approved by the payers of the long-term care system. The proper sources of care are recognized and implemented, catering to the client’s needs. The next step is the implementation and coordination of the care activities. This phase allows for the execution of the interventions and activities that are appropriate for the client to undertake. These activities and interventions are based around the goals and objectives created from the assessment phase. Coordination of care occurs, resulting in the case manager sharing information with the client and the team, assigned tasks to the interdisciplinary team. The case manager’s plan of action gets implemented, allowing the proper professionals of the long term care system to work with the client. After the implementation process, is the evaluation of the case management plan and follow up. This phase allows for the evaluation of the clients status and goals, to determine if they were achieved or not. The outcomes are evaluated to determine if the plan of care needs to be modified or left the same. The case managers gather information from all members of the team, and share that information with the client, their family, and the healthcare providers. This allows for modifications to be made within the care plan to adjust to the client’s needs. Once this occurs, a reassessment is in order, repeating this cycle. If the individual has improved and is able to take care of himself or herself, then the termination of the case manager’s plan occurs. The final core step of the case manager is the termination of the case management process.
This occurs when the individual is at their highest optimal level of self-sufficiency or a transition of care is in need. The individual can be discharged to their home or can be placed in another facility of long term care, depending on their outcome. The case manager educates the individual and their family about transitional care and a follow up assessment, sharing the necessary information during their transitional process. After the transition, the case manager checks up on the individual to see if their new form of care is catering to their needs. If problems occur or the proper care is not being given to the individual, the case manager communicates to the payers and providers to make sure that issue is resolved. The case manager then writes a summary report on various aspects of the case, relaying that information to proper members of the long-term care system …show more content…
team. Furthermore, case management has issues relating to their process of creating a care plan.
Case managers have a great amount of power and impact on how much and what type of care a client can receive. If the case manager deems the specific care for an individual to be too expensive (even though that individual truly needs the care), they can control for that care not to occur. The case manager is the person who controls an individual’s access to care and that can be unfair. Another issue with case management is that all their clients are of completely different backgrounds. Every culture functions differently, due to their own specific customs, beliefs and traditions. Case managers truly need to keep that into consideration when creating a plan of care for the individual. Case managers need to respect the individual and realize that even though two individuals have the same disability, due to their cultural background, the situation needs to be treated differently. The treatment plan should not conflict with the traditions of the individual and their family. Ways to improve these issues is for case managers to adjust the treatment plans for those individuals who truly need specific care and for those whose treatment plans do not work well with their culture. The case manager needs to educate their clients on why the decision was made, and why that certain type of treatment is the best. In the end, the case manager needs to respect their client, and be aware of the cultural
differences preset.
Within the U.S. Healthcare system there are different levels of healthcare; Long-Term Care also known as (LTC), Integrative Care, and Mental Health. While these services are contained within in the U.S. Healthcare system, they function on dissimilar levels.
D1: I have decided to look at a 6 year old going through bereavement. Bereavement means to lose an individual very close to you. When children go through bereavement they are most likely to feel sad and upset about the person’s death. Children at a young age may not understand when a family member dies. Children may not understand bereavement. For example a 6 year old’s father been in a car crash and has died from that incident. Death is unpredictable and children can’t be prepared for a death of a family member as no one knows when someone is going to die or not. Unfortunately every child can experience bereavement even when a pet dies. It is important that we are aware that effects on the child so we can support them in the aftermath.
Long-term care (LTC) covers a wide range of clinical and social services for those who need assistance due to functional limitations. These limitations usually result from complications associated with age related chronic conditions, from disabilities related to birth defects, brain damage, or mental retardation in children; or from major illnesses or injuries suffered by adults (Shi L. & Singh D.A., 2011). LTC encompasses a variety of services including traditional clinical services, social services and housing. Unlike acute care, long-term care is much more complicated and has objectives that are much harder to measure. Acute care mainly focuses on returning patients to their previous functional level and is primarily provided by specialty providers. However, LTC mainly focuses on preventing the physical and mental deterioration of an individual and promoting social adjustments to suit the different stages of decline. In addition the providers of LTC are more diverse than those in acute care and is offered in both formal and informal settings, which include: hospitals, physicians, home care, adult day care, nursing home care, assisted living and even informal caregivers such as friends and family members. Long-term care services have been dominated by community based services, which include informal care (86%, about 10 to 11 million) and formal institutional care delivered in nursing facilities (14%, 1.6 million) (McCall, 2001). Of more than the 10 million Americans estimated to require LTC services, 58% are elderly and 42% are under the age of 65 (Shi L. & Singh D.A., 2011). The users of LTC are either frail elderly or disabled and because of the specific care needs of this population, the care varies based on an indiv...
Nurse case management serve an important role in the hospital. They identify needs of the patient prior to discharge and help allocate resources to them as well. Case management is a collaborative process, they work with physicians, nurses, social workers and other healthcare professionals. The role of the case manager includes working to meet the complex needs of patients. They also make provisions for current and future needs, promotes quality care, and facilitates the use of appropriate allocation of resources. The case manager is also in charge of ensuring that ethical and legal issues are met and addressed for each individual patient. They need to have a great knowledge base on government, public, private insurance reimbursement policies in regards to their healthcare facility. Furthermore, they review charts and have meetings with healthcare professionals to ensure that the patient is receiving the proper level of care. Finally, they mediate and facilitate during the admission and discharge process of the patient.
Nursing case management does not take the place of the nursing care delivery model in place to provide direct patient care, but supplements nursing care in a health care facility (Jacob & Cherry, 2007). For example, if a hospital’s medical-surgical unit uses a team nursing approach to patient care, a system of case management might also be in place to assist with coordinating the patient’s total care through discharge (Jacob & Cherry, 2007). Moreover, case management is not always necessary for every patient in a health care facility. Typically, case management is generally reserved for the seriously ill or injured, chronically ill, and high cost cases (Jacob & Cherry, 2007). In brief, case managers are a unique segment of the healthcare workforce.
Case management – Case managers help aftercare patients locate the resources they need to build successful lives in the community.
According to the Case Management Society of America, case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes" (Case Management Society of America [CMSA], 2010). As a method, case management has moved to the forefront of social work practice. The social work profession, along with other fields of study, recognizes the difficulty of locating and accessing comprehensive services to meet needs. Therefore, case managers work with these
The goal of case management is to come to the point that the client’s to the point of termination of case management and the client is released. There are different strategies the case management can use in order to ensure his or her client remains successful after termination has been made. Strategies that can be used is communicating with everyone involved in the case including family and friends, risk assessment, and setting up community resources before termination has been made. It is also important to encourage and set up independent care in order to prompt client’s growth. Case management termination is a huge step for the client and a very important step when treating clients in case management.
without a shelter, and homeless due to release from any institutionalized facilities. People living in a shelter and are monitored by the facility under case management. Case management is position held by the facility administrator who makes sure that the individual applies themselves the best way possible to the assorted task...
Having a group of senior citizens following you around for dinner most likely doesn’t sound like a fun night. However, working at a nursing home doesn’t feel like an actual job at all; I actually enjoy spending my nights at the Grand Residence. Not only has this job given me responsibility, but I also have built relationships with many residents. While spending my evenings at a nursing home throughout my high school career, I have come to the realization that I am comfortable and genuinely happy with pursuing a career in patient care in the foreseeable future.
Overall, case management provides community mental health care to clients who often suffer from severe mental disorders or other various illnesses. Case management practices are person-centered, as they focus on improving individual support systems. These practices also maintain a person in environment framework, which allow
According to IC & RC, Case Management is defined as, “activities intended to bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established goals. It may involve liaison activities and collateral contacts” (Herdman, John W., 6th Edition). Case management is a concerted effort of various professionals in the human social services network that assess’, plans, implements, coordinates,
Increased life expectancies have many reconsidering whether the fountain of youth is merely a legend. For many families, longer life spans have allowed them to spend more time with loved ones, time that may not paint the picture imagined.
As a case manager we are “to coordinate needed services provided by any number of agencies, organizations, or facilities” (Kirst-Ashman & Hull, 2015, p. 31). Not only did she advocate for health services for Brenna but she also working on her housing issue, helped her set up a monthly food budget, helped her find counseling, and helped her build a support network (Kirst-Ashman & Hull, 2015, p. 32). By providing Brenna with all of these resources the case manager is building up her self-worth and showing her that even though she had some hard times she can survive and make better for herself and her
Case management assists in tracking needs, progress, and changes as clients receive services for these goals. While counseling and