Case management paper
Case management refers to a process where an individual care is planned, coordinated and reviewed. It is a tool that is established with aim of integrating services with the need of a person who has long-term conditions (Gursansky, Harvey, Kennedy,2003).Its work is fully realized when it is used as a part of a larger care program where various strategies are used in for care integration purposes. It allows an individual’s assessment in terms of current ability level and their social care and physical care needs. Case management help the clients’ to select the resources and services which have the best possible quality within the confines of available range of care services. In the assessment process, the case manager carries out an evaluation of the accessible care options and understands them. They use this knowledge in the determination of the best option to meet the needs of the client and afterwards institute actions aimed at achieving care services goals and meet their expectations. The manager, therefore, identifies the major problems facing the client, their personal needs and interests and establishes a plan for case management which will address the recognized needs and problems (Kohleis, 2009). This involves gathering information using various tolls such as face-to-face, telephonically, the support system for the client and the staff involved in providing care to the client. Though case management has been a part of social work in the community since social work as profession was founded, it has with time became integrated into the whole system which is community based. Since the 19th Century it has become specialized and widespread. The early caseworkers saw themselves as just benevolent but later started recognizing themselves as partners with clients. Through this, the case managers found themselves integrating t with professionals such as nurses (Herman, 2013).
The roles and responsibilities of case manager involve the assessment, evaluation and satisfaction of the needs of the clients and achieving the anticipated outcomes in the pre-hospitalization to the post –hospitalization period. The managers oversee that clients are provided with the right care services as outlined in the plan within the allocated time. The mangers responsibilities also include welcoming the client and other parties such as family members and establish an efficient way of communicating with them. They have to identify the expectation of the client arising from the aforementioned needs and carry out an assessment of available resources and support network. The manager should then develop a plan with the help of a multidisciplinary team. It is the responsibility of the manger to bring all consultants together when time is appropriate. Through this, he is able to coordinate all the examinations, tests, care and consultations in accordance with the client’s conditions and the established plan (Gursansky, Harvey, Kennedy, 2003). The manager should also ensure that assessment of clients needs is done within the scheduled time. To ensure that there is a continuous care provision, the manager should avoid fragmenting and duplicating the services by getting involved in the whole management. To achieve this, he should work as the major supervisor and provide information and education to the client and his entire support group such as family members. He should also facilitate information flow among multidisciplinary members. It is also the manager’s responsibility to identify any variance between the planned objectives and actual outcomes of the pathway plan. Participate in performance report preparation and encourage others participants like nurses to get involved in the whole report (Gursansky, Harvey, Kennedy, 2003).
The various type of case management offered in the community is majorly the health care services which comprises of mental and medical nursing care services. The programs involved in the provision of the medical care services include the Medicaid, Medicare, Veterans Health Administration and the Children’s Health Insurance Program. These programs normally provide insurance services to the clients which covers their medical expenses. The agencies for medical services includes The National Institute for Occupational Safety and Health whose main role is to ensure safety and health among all individuals in a working place ,the Centers for Medicare and Medicaid Services that administers the aforementioned programs especially on health insurance. Health Resources and Services Administration agency is tasked with the role of ensuring there is improvement in health care services for the individuals who isolated and uninsured and thus medically vulnerable (Green & Rowell, 2013).
The type of medical insurance undertaken by an individual determines the kind of health services accessible to them. These policies influence the barriers to health care, including both the geographical access and the quality of services and the relevant information. For instance, having Medicaid coverage is way better than being uninsured at all in terms of access to utilization, care and the various unmet needs. Therefore, individuals with who are covered by Medicaid are more likely to receive better care services and are less likely to have unsatisfied needs because of high costs(Green & Rowell, 2013). Another factor influencing the accessibility to healthcare services is duration of the medical insurance policy taken. Individuals with short-term health insurance are only offered coverage with limited health benefits. This means that, although the major medical insurance policies can be expensive, they provide better benefits. In addition, lack of medical insurance is a major barrier to health care services. Patients without medical insurance are inhibited by the cost, such that essential services like drugs get out of reach. The groups of people who have a big increase in the medical insurance coverage, especially at 65 years realize a significant reduction in the likelihood of not receiving or delaying health services. The individuals also increase their frequencies of visiting doctors and necessary medical check-ups. The programs that offer services to the general public or community like employee mandatory health insurance can result to increased access to health care and therefore reduced mortality rates (Green & Rowell, 2013).
In a real world , when handing a client with AIDS condition , and whose needs includes both social and medical , a assessment would be necessary in order to direct all attention to those needs. This would include understanding the effects of any single step taken to solve their problems and satisfy their needs. As a manager, it requires being conversant with epidemiology, routes for transmission, and the clinical progression of the disease, legal and financial implications. It would require recognizing the social services available and the various psychotherapeutic strategies that would assist the patient to overcome fear and grief. This would involve the incorporation of the other experts and professionals to satisfy all the client’s needs (Herman, 2013). This is necessary for one to remain aware of their expertise or knowledge limitations. All the approaches would be successful if an evaluation of client’s individual beliefs and attitude about their problems. The area that I would like to train on is medical case management. As a manger I would work as a social worker would ensure there is proper patient care and discharges. I would also provide necessary referrals to various organizations offering community services and ensure supplies and equipment for the clients availed. This arises from my desire to see that patients have coordinated and timely access to quality services and the appropriate degree of mental health, and support services that are continuous (Herman, 2013). I would also be able to offer consultations to the clients provide necessary information to them and clinically carry an assessment of their needs. This will allow me to meet the various cases of community needs. I have learnt that the function of a social worker is very important especially in the case of people with medical needs. These clients go through a difficult time trying to meet their social and physical needs and without a proper plan to assist them, mortality rate would increase considerably.
Case management has stood out as a collaborative process that involves meeting the needs of a family or individual or the whole community. It is a discipline based on the single fact that everyone will benefit when a person is able to attain their optimum degree of wellness and is able to function fully. It is thus a way of achieving the community well being when individual needs are met. The services involved in case management are provided when all parties are involved.
References
Kohleis P. (2009) Essential Case Management: Make a Dent in Your World. Yeronga: Peter Kohleis Pty Limited.95
Gursansky D., Harvey J., Kennedy R. (2003).Case Management: Policy, Practice and Professional Business Columbia University Press.
Green, M. A., & Rowell, J. A. C. (2013). Understanding health insurance: A guide to billing and reimbursement. Clifton Park, NY: Delmar Cengage Learning.
Herman, C. (2013).The Evolving Context of Social Work Case
Management: NASW Releases Revised Standards of Practice. Retrieved from: https://www.socialworkers.org/assets/secured/documents/practice/Case%20Management%20Standards.pdf
