Case Management: A Social Worker’s Perspective
When people first hear the words “Case Management,” they generally think of discharge planning. However, case management is more in-depth and involved than just discharge planning. There are multiple layers to case management that include utilization review, utilization management, connecting resources for patients, and patient education. At the same time, they move through the levels of care, and of course, advocating for a patient to ensure they are transiting through the levels of care with the best outcomes as possible. Honestly, the previously mentioned items are just touching the basics of what case management is.
Being a case manager is more than just following a clear set of guidelines while working with patients. Short et al. (2019) explained an increase in medical services and social and welfare services are becoming more apparent for the general population. Just like every snowflake is different, every person is also different. Some patients may require more extensive planning, guidance, and education while navigating through various levels of care. There has been more reliance from the general population on healthcare facilities for more than just medical needs in recent years. Patients are presenting with chronic illnesses. Some of these illnesses are being exacerbated by social issues, such as lack of resources, lack of education regarding the disease process, lack of a support system being in place, and the list goes on from there.
Additionally, multiple healthcare entities are either currently forming or have formed contractual agreements with other healthcare entities to ensure they are all making a profit to keep their doors open to serve the patients’ ever-growing needs. While this is good for business, this leads to confusion for patients. Patients are not understanding the role of each healthcare setting they are currently being treated at. For example, a patient who does have long term acute care needs would likely benefit more from an LTACH, versus an acute care hospital. This example shows where case management proves to be not only beneficial but essential for patients to have the best outcomes possible.
Case managers can be seen as both the “good and bad cop” from a patient’s perspective, depending on the situation. The good cop, if case managers can connect a patient with great resources, leading to the best outcomes. Additionally, for a case manager to be seen as a “good cop,” the patient is generally also satisfied with the results. Sadly, this could also lead to a case manager being seen as a “bad cop” if the patient disagrees with the presented options on the flip side. Such as a case, where an individual underwent a traumatic injury and they do not identify as being “ready” for the next level of care, which could include skilled nursing facilities, home with home health therapy, etc. During times such as these, case managers are also tasked with explaining to the patients the risks of staying in an acute care setting, which could include, but are not limited to, hospital-acquired infections and insurance companies rejecting a bill for services rendered at the current level of care. Additionally, case managers could serve as a contact person for a patient’s loved ones when they are not sure what to expect next in a disease process.
While case management can seem like much work, it is also one of the most rewarding careers a person can choose to go into if they have the heart for it. Just like any other helping profession, it is not possible to train someone to care. However, if someone does have a “calling” for case management, it is a career you can hang your hat upon, feeling like you have made a difference in someone’s life. Not only with clients, the agencies that a case manager is employed with will also turn to the case manager to be the subject expert in multiple areas. This leads to the need to have multiple disciplines working in the role of a case manager. Each discipline will view a problem a patient or client is having with a different set of eyes. Nursing backgrounds will be able to understand better the clinical aspect of the needs of a patient. In contrast, a social work background will allow for the social needs to be met for a patient, such as a lack of resources contributing to a patient appearing to be nonadherent with a treatment plan.
Short, M., Trembath, K. S., Duncombe, R., Whitaker, L., & Wiman, G. (2019). Contemporizing teaching case management: mapping the tensions. Social Work Education, 38(2), 212–226. https://doi.org/10.1080/02615479.2018.1506428
Guest post from Jared D. Johnson, MSW, LMSW, CCM, submitted as part of our “Case Management Is… Contest” and selected as an Honorable Mention!
My name is Jared “Jay”, I am a case manager supervisor in middle Ga. I have worked in various areas of healthcare for about 6 years now. I have worked in skilled nursing facilities, acute care hospitals, and rehab facilities. Also, a proud fur parent.