Case Management Is….

What is case management?  That is a loaded question that could entertain thousands of answers.  It may be easier to discuss what case management is not but that is not what is going to happen in this essay.  Case managers are involved in the critical aspects of the patient’s care that does not involve a cardiac monitor or a Levophed drip.  Case managers take care of the stick situations that cannot be resolved with a PRN medication or by repositioning the patient every two hours. A few components of case management include assessment of patients, assessment of families and caregivers, listening to patients, communication with fellow staff members, following and explaining Medicare guidelines, discharge planning, and changing a discharge plan on the day of discharge (just to name a few).  All of these come down to one goal: The success of the patient.  The success of the patient after hospitalization means something different for each patient.  Each patient has a unique goal for the discharge plan.  A successful discharge plan, in general, is one that allows the patient to be safe and healthy in their home environment, wherever that may be.  

Advocacy, education, coordination of care, transition management, and cultural sensitivity are a few of the tools of case management.  Using these tools and working with a multidisciplinary team are what help lead to the success of the patient at discharge.  Having the right supports, having appropriate medical follow-up care, having medications, and understanding all of these items, are critical to the patient’s discharge plan.  Case managers are the staff that is looked to for working out the problems that hinder the discharge of a patient from a medical care setting. 

Case managers, along with the physicians and nursing staff, help the diabetic patient to understand the importance of keeping appointments with their primary care physician and the dietician. When patients are educated on the importance of follow up, it will help maintain and improve the health of the patients.  Case management educates the patient and family on what the home health agency can do to help in the transition between the hospital and the patient no longer requiring skilled interventions.  The education provided by case managers is vital for patients and families to understand Medicare guidelines and the rights of Medicare recipients.  Providing knowledge to the patient and caregiver empowers the individual to make appropriate decisions about health care. 

Sometimes case managers advocate for a patient in a way that is not well accepted by others.  As a case manager, I have advocated for my patient to make the decision that the patient wanted-but no one else wanted for the patient.  The decision was for hospice.  Case managers are the patient’s voice in many instances, helping to explain to family and sometimes physicians, that the patient’s wish is to not return to the hospital but to be comfortable at home.  That patient’s discharge success is to live life on their terms for however long that may be.  The goal is for the patient to be safe and healthy in the home environment.  Advocating for hospice can help the patient to meet that goal.  

Case management, coordination of care, and transition of care just seem to go hand in hand.  Case managers know the fax numbers by heart of the local nursing home and DME companies.  This is such an important piece of the case management pie.  Ensuring medications or prescriptions are received, transportation is arranged, and the discharge summary is sent helps to ensure the continuity of care for the patient.  This piece helps to assure the patient’s health will continue to be watched, ensuring any adverse events can be managed with the least interruption of the patient’s life. 

Case management is now about following up with the patient after discharge to check on the success of the discharge plan.  Calling the patient after discharge was not a standard of practice that I was taught as a new case manager, many years ago.  It is now a routine part of the day to call the patient after discharge to see how the patient is doing at home.  Case managers are involved in helping with situations that may arise a couple of days after discharge. People change their minds.  Case managers are well versed in the knowledge that a patient may decide that the home health was the better idea for managing the IV antibiotic for six weeks, instead of outpatient.  It may mean contacting the hospitalist because the prescription was not at the correct pharmacy.  Case management continues to support and encourage an effective discharge plan even after discharge. 

Google dictionary defines success as “the accomplishment of an aim or purpose.”  Case management’s purpose is to provide direction and guidance for patients, families, and caregivers.  The aim for case management should always be for the patients’ goals to be met that return the patient to an optimal level of functioning.  Case management is made up of many responsibilities, ideas, and skills.  It would be near impossible to list all that “case management is.”  But case management is definitely compassion, knowledge, sprinkled with decision making to help patients’ families have success in managing their health.     

Guest post from Rose Wissiup, RN, Director of Case Management, submitted as part of our “Case Management Is… Contest” and selected as an Honorable Mention!

I am Rose Wissiup. I live in Artesia, NM with my husband and children. I have been in the nursing profession for over 25 years. I have worked in a variety of settings as a nurse. I started my nursing career in Georgia at a psychiatric hospital. I have ventured to Arizona, Texas, and New Mexico as a nurse. I have worked emergency room, home health, home hospice, geri-psych, rural hospitals, and obstetrics.