National Family Caregivers Month

As a case management company that helps in coordinating ongoing care for patients with serious or chronic illnesses, we know all too well the monumentally important role that family caregivers play in the recovery of, and continuing challenges faced by, their loved ones.  This November (and every month of the year), we would like to join with the Nation in recognizing, encouraging and supporting these “heroes” for all they do, day in and day out, to assist in maintaining the health of those in need.

The National Family Caregivers Association (NFCA) was the first to ‘celebrate’ these family caregivers in 1994 by announcing National Family Caregivers Week.  The first proclamation issued by a President in recognition of family caregivers was done in 1997 by President Clinton.  In his proclamation this year, President Obama honored family caregivers for “…bringing comfort and friendship to treasured citizens” and acknowledging the “…heavy emotional, physical and financial toll…” that dedicated care giving can have on family members.

It’s estimated that family caregivers are the ones in America these days to step up to the plate in 80 percent of long-term care scenarios, translating into a calculated $375 billion of home health care.  The largest demographic age group in the United States (47 million)…the Baby Boomers…is now beginning to face the role of caregiver for aging parents, as well as other relatives and friends.   A recent 12-month survey by the NFCA reported 26.6 percent (or approximately 54 million people) had been involved in care giving over that time span, 56 percent of who were female and 44 percent male.  In addition, according to the Family Caregiver Alliance, single parents make up 75 percent of the caregivers in homes with seriously ill children.

Taking these statistics into consideration, it’s glaringly apparent that these caregivers have made a huge commitment to their children, parents, and other loved ones… one that comes with a great deal of sacrifice.   Of utmost importance is that these caregivers find time and put forth the effort to maintain their own health and well-being.  To that end, we would like to suggest the following recommendations and resources:

• Family caregivers need personal time to take care of their own needs.  They need to remember “caregiver” is just one of their identities; it’s important to nurture the others.
• Be sure to spend time with friends and family; have some fun.
• Don’t try to do it all.  Look into flextime or paid family leave to lighten the load a little.
• Check on independent services that can help, such as home health care, and case management companies, such as Health Management Connect, that can ease stress through education, resources, and support.

Organizations and associations that can help include:

• Family Caregiver Alliance –  (800-445-8106)
• Andre Sobel River of Life Foundation
• National Family Caregivers Association
• Family Care Giving 101

If you know of someone who is responsible for providing care giving for a loved one, reach out to him or her this month in recognition of his or her efforts.  If you are a caregiver, be sure to avail yourself of resources available to you.  As Family Care Giving 101’s theme for caregivers this month suggests:

BELIEVE in Yourself…PROTECT your health…REACH OUT for help

What Can a Case Manager Do?

Depending upon who a case manager is employed by, whether it is an independent company, the entity providing medical care or the organization underwriting the insurance for an employer, there may be benefits and services which are provided that aren’t known about or considered by those enlisting a case manager’s aid.  Let’s take a look at just a few:

• Coordination and facilitation of patient care and the prescribed treatment plan

This may seem obvious, but it goes beyond the obvious when you consider that, because of their experience, case managers can make a huge difference in making sure the patient’s treatment plan is carried out in an effective and organized way.

• Continuity/Transition of Care

Case managers will oversee the transition of care to be sure important care issues don’t fall between the cracks, compromising the patient’s health and recovery outcome.  The case manager can be a liaison between not only physicians or specialists when care is transitioned from one to another, but also transitions between facilities or a care facility and home.

• Performance and Outcomes Management

Because a case manager takes charge of the previous two items, the patient’s progress is monitored closely to be sure steps within the treatment plan are implemented as needed.  It’s the case manager’s job to know if a patient needs to be guided back on track to insure the outcome of his or her treatment is as successful as possible.

• Integrated Health Management/Holistic Considerations

A case manager, when able to work closely with the patient, becomes very familiar with not only the physical aspects of the patient’s health, but also the mental and behavioral aspects, which will have an impact on the physical health of that patient.  Through the insights provided by a case manager in the area of integrated health, a patient’s treatment outcomes can be positively impacted and improved.

• Advocacy and Education

Part of a case manager’s responsibility is to assist the patient in becoming an advocate for his or her medical treatment and care.  It is extremely important to educate patients about the services that are at their disposal and how to gain access to them once they are on their own outside a medical facility.  It is also imperative to educate them on their illness or disease and how they can improve their future health outcomes by exercising preventive measures and following the treatment protocol set up for them.  They need to have the knowledge that will help them to be proactive and keep them out of the hospital and, hopefully, even the doctor’s office, down the road.

• Utilization/Financial Management

The financial aspects of patient care are also a major focus for all involved.  Case managers can oversee that the most effective resources are utilized for a patient’s care, that there aren’t duplications occurring or inefficiencies taking place that can mean unnecessary dollars being spent.  Case managers are also able to negotiate with out-of-network providers and/or, if necessary, work with secondary coverage plans to be sure all options are taken advantage of.

When working with an independent case management company, such as Primary Pediatric Management, you may also have extra services provided, such as:

• Onsite and telephone case management
• Workmen’s Compensation case management
• Legal Nurse Consulting
• Life Care Planning
• Wellness Programs
• Utilization Reviews

The broad spectrum of care management that can be provided when enlisting the services of Case Managers is highly valuable to everyone involved…from the patient to the physicians and medical staff to the insurers.  If you have questions about case management and how it can best serve your needs, please feel free to comment on this post.

Chronic Care Patients and Case Management

Providing or obtaining health care insurance for individuals and families in the U.S. these days is not an easy endeavor whether you’re the government, an employer, self-employed or unemployed!  Costs rise each year with, it seems, no end in sight.

When employers insure their employees, statistics show 85% of their costs can be attributed to 15% of those covered, a good portion of which is for medical expenses claimed by individuals with chronic illnesses.  Three of every four dollars in our country are spent on treating chronic diseases.  Those illnesses include diabetes, asthma, hypertension, congestive heart failure, etc.  People with chronic diseases account for 75% of our nation’s health care costs totaling well over $1 trillion, and their average healthcare costs are generally about five times that of someone without a chronic condition.

The challenge is finding ways to positively impact the long-term health of those with chronic disease issues, saving them from increases in medications and visits to the doctor or hospital, which in turn can mean cost savings for the employer, insurance company AND the patient.  In essence, the catalysts for more frequent doctor visits or hospitalizations are:

• Lack of communication between patients and physicians
• Lack of education for the patients
• Lack of adherence on the part of patients to their treatment plans
• Lack of awareness; not addressing a problem soon enough

Case managers can be an integral part of a treatment plan for these individuals.  In the past, we’ve talked about transitions of care and how the role case management plays can improve upon the outcomes experienced.  Although there are obviously opportunities for case managers to be involved in transitions of care for those with chronic illnesses, a much needed intervention for these patients is in the areas of education, guidance, and self-management.

Case managers, because it is a part of their “job description”, are able to focus their efforts on working with everyone involved to help create strategies for the patient that can meet the goal of sustaining improved health milestones, while also working on prevention knowledge and confidence.  Case managers are also a prime source for finding resources within the patients’ communities that can provide support and, hopefully, prevent the need for an unexpected doctor or emergency room visit.

Because their needs are ongoing, those with chronic diseases require a different approach to their case management.  It’s especially important for them to focus on long-term treatment options, learn to be conscientious about following their treatment guidelines, and prevention.  Patients need to become comfortable with, and accepting of, the lifestyle changes that are usually necessary, and a case manager can assist them in that goal.

Eventually, effective self-management of their day-to-day disease symptoms and routines is a major milestone to be achieved and supported by the case manager, physicians, and their families, as well.   Their support is vital to building a patient’s confidence in the ability to gain “control” over his or her life and health.  When this goal is met, the maintenance costs for meeting a chronically ill person’s health care needs can more likely be contained at a level that is more affordable to everyone affected by his or her health care coverage.

Case Managers and Reducing Medication Errors

As defined by the National Coordinating Council for Medication Error Reporting and Prevention, a medication error is:

…any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.

These medication errors can involve anyone who has a piece of the responsibility for the administration of the prescribed drugs, from the doctors to the patients and everyone in between.  Even parents, who are often the ones responsible for dispensing medications to their chronically ill children once they are home, can get it wrong no matter how well-intentioned they may be.

Statistics from a five-year period in the late 90s showed the highest percentage of these errors to be from improper dosing caused by care givers who weren’t knowledgeable enough or simply administered the medication incorrectly.  Obviously, children are a high-risk group when it comes to medication errors, since they are at the mercy of those who are caring for them; and because often times, it takes specific calculations to get the dosing right, depending on a child’s weight.

This is when having a Case Manager involved can be such an added advantage to insuring a patient’s recovery free of medication errors.  Education is a vital aspect of the Case Manager’s role with parents and patients.  It’s important for the care givers to understand what drugs are being taken and what part they play in the patient’s recovery.  Deciphering the directions for taking them is also a huge help to those responsible once the patient is home.

Also, because of their backgrounds and the role they play, Case Managers have the ears of doctors, nurses, and other medical staff.  Through interaction with the patient and/or family,  it can be assured the medical team is aware of anything that is being taken outside the hospital or clinical setting that could create an adverse reaction.

Ideally, Case Managers work to encourage parents and patients to be advocates for themselves throughout a medical crisis or chronic illness, building their confidence to ask questions when something seems remiss or not quite right.  This can definitely go a long way toward preventing a mistake that could cause a recurrence, relapse or worsening of the condition, requiring further hospitalization and medical care…and higher medical costs.

While working with the families and patients in the hospital setting and during transitions of care, a Case Manager can be invaluable as a liaison between them and the medical staff/team.   Not only can Case Managers assess staffing needs, experience levels, and resources, but they can also oversee patient care to make sure nothing important falls through the cracks in regards to medication and other patient needs.   If necessary, it is their responsibility to intervene and collaborate with all involved to insure the best outcomes possible, both from a health standpoint and a cost standpoint.

Of prime importance is what Case Managers are promoting by their involvement, and that is a patient-centered approach to treatment, which includes administering medications.  When there is consistency with staffing and staff members get to know the patients, it has been shown to decrease errors.  Being focused on the patient means there is more attention paid to possible adverse reactions and whether or not the medication is having the effect the doctors are looking for.  With Case Managers, the patient focus doesn’t stop there, but also continues to be sure that the follow up is done in order to observe the end result.

As an integral part of a medical team, as well as an advocate for patients and insuring parties, a Case Manager can have a positive impact on the reduction of medication errors, and…in the process…the reduction in further medical treatments and expenses.

Case Management and Transition of Care

In case management, when we talk about Transition of Care, we’re referring to what is done for patients who are moved from one location to another and/or new levels of treatment during their health care process.  This includes any move, whether it’s from the ER to an in-patient bed, ICU to “the floor”, or in-patient care to home.

So what exactly is done within the context of this Transition of Care?  Part of our responsibility during this critical time is to ensure that our patients don’t get lost in the shuffle or fall between the cracks.  We coordinate the continuity of care by building a bridge between all the involved parties…physicians from different departments and disciplines, nurses, pharmacists, home health care and others… making sure that everyone is on the same page each step of the way.

Of great importance is the involvement of family members who are either standing watch during hospital stays or who will be caregivers once the patient is released to go home to recover.  It’s our goal to help our patients and their families succeed at whichever step comes next in their medical regimen.   Part of our transition plan is to provide patients and families the knowledge they need to understand what is coming during this change and share an awareness of problems that may arise, as well as how to deal with them.

We place a great deal of emphasis on collaborating with all health care providers and parents so that our patients are set up to succeed at the next level of care.  It’s important to have all our ducks in a row before moving a patient to that next level, with resources in place in order to avoid a potential failure during the transition, taking a proactive approach, rather than reactive.

Because re-hospitalization is a real and common issue among those who are chronically ill, a well-coordinated transition of care plan can save patients and families enormous amounts of stress, both emotionally and physically, while at the same time save on the expense of being re-admitted to a health-care facility again.

Enough can’t be said about the emphasis that should be placed on transition of care for all who are a part of a patient’s recovery.  If you have a transition of care question or story you’d like to share, we’d love to hear from you.

Case Managers and Patient Advocates

Recently, while watching the Nightly Business Report on PBS, I heard a report on up-and-coming careers for the next decade.  One of the careers discussed was that of the patient advocate.  What I found a little distressing was the statement, “Almost anyone can call himself or herself a generic patient advocate. There are no real licensing requirements or professional certifications.”  You could say this is true if you consider a patient advocate as strictly someone who helps patients when it comes to conflict with agencies, insurance companies, billing departments, etc.  (although it would be beneficial to know his or her background and experience before committing to a “relationship”).  However, patient advocacy is a huge piece of the case management puzzle, and the description in the quote above is not at all indicative of what you will find when dealing with a professional Case Manager.

As a Case Manager, it’s important to me that patients understand the services and benefits offered by case management.  It is extremely important that patients know they are getting guidance and assistance from a reputable company and/or Case Manager.  It’s vital to be sure those working with you have or are seeking certification in case management (Commission for Case Manager Certification – CCMC ) and are members of a regulatory agency that monitors the field of Case Management (Case Management Society of America – CMSA).  Typically, an experienced, professional  Case Manager also has a previous license in a field, such as nursing, social work or therapy.  In a burgeoning field, such as case management/patient advocacy…and in an economy where there are many looking for a job or new career…doing “due diligence” before you work closely with someone on such an important issue can’t be minimized.

There are many facets to Case Management.  To generalize, it’s a Case Manager’s responsibility to make sure patients receive the best possible care so they can realize the best possible outcome.  Within that realm, Case Managers want to help ensure your medical services and health care consumer dollars are not over utilized, wasted or used unnecessarily.

Case Managers will help you assess your treatment, while working with your doctors and insurance company to facilitate a plan for your care.  We can assist you with resources and services needed for effective treatment and a healthy recovery. We will also educate you with information and actions that can help you for the rest of your life in dealing with chronic illness and also prevention for repeat episodic events. Case management (inclusive of patient advocacy) isn’t about managing you…it’s about helping to manage what you are dealing with in regards to your health issues, getting to know what’s important to you, and then advocating for you.