Understanding the role of Case Management in the Rehabilitation Process

 

Understanding the role ofCase Managementin the Rehabilitation Process

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Abstract

This proposal will explain the role ofcase management in the rehabilitation process. The role of a case manager is to address the “whole person” in the rehabilitation of that client or patient.  Since it is not easy to separate the vocational form the medical, we must consider this role of the casemanager as an important placement that is widely needed in many organizations.

First, we must understand and define what a case manageris and what categories of clients they serve.Often in most organizations this quality of care must be provided in a cost-effective manner.

Second,this proposal will cover the many functions of a case manager to how it has become an important part of any organization or health care team.  These functions will explain whytoday a casemanagement is oftenconsidered a specialty in the field of rehabilitation counseling.  And in explaining such functions, further knowledge of the exact process of acase managerwill also be clarified in moredetail.

Third, weneed toconsider the important value, purpose, and benefit in hiring a case managerwithin an organization and how this can benefit an individualclient or patient.  This work can be very crucial to the success of the client overall success and well-being. Also, amore in-depth explanationin how organizations, health care teams and clients can benefit from a case manager’s expertise.

Last in summarizing, throughout this proposal these questions will be answered, “what? who? how? and the why?” Covering knowledge that was gained in researching the role of case managementregarding the rehabilitation process.

“What is case management?”

To understand case management further we first need to define it, here are two definitions, “case management is a collaborative process that promotes quality of care and cost effective outcomes which enhance the physical, psycho-social and vocational health of individuals” (Coppa et al. 1996 p.7).  And a second definition, “case management is a system of care delivery that focus on the achievement of appropriate patient outcome with effective time and resource parameters” (Coppa et al. 1962 p.7). “Because the medical cannot be separated from the vocational in many cases, vocational rehabilitation counselors are starting to be recognized more and more as “case managers”, and they are eager to improve their overall skill in this area” (Coppa et al. 1962).

“What is their role? And Who is involved in case management?

When we hear of the role of “case manager” we often think of a RN Nurse that handles various medical issues.  The confusion comes in when we hear of a “rehabilitation vocational counselor” it was discovered that both occupational titles hold substantial overlap in the services they offer.

Cost of these services is another huge issue for a workforce or organization.  In the ideal world both professions would be available to a client at high levels for both medical and vocational expertise.

Addressing the “whole person” and encompass more than just medical issues is important since many people are living and working longer than ever.  Working Americans are expected to retire at age 66, which is up from 2002 according to Gallop Poll of 2018.  Since 2011 average age was 61 to retire (Brandon, 2019).  This indicates most retirees plan to stay in their jobs for five years or longer than originally expected.

 

Interpreting case management often will involve working with individuals involving three main categories: medical care, psychological care, or vocational assistance.  Let us look at all three of these categories, medical care management can encompass discharge planning an assist the client in the transition of long-term care, skilled nursing facility or home.  Skilled nursing facilities include nursing homes, intermediate care facilities and extended care facilities.  Home health care services and outpatient treatment may require coordination with nurses, occupation and physical therapists, speech pathologists, audiologists, prosthetists, and orthotists and other medical care.  Along with medical care psychological issues may also need to be addressed.

Psychological care management may assist the client in referral to a medical health professional for further evaluations or they may be required to help them find half-way housing,, or a referral to an addiction rehabilitation facility may be necessary.

Vocational case management requires that a RC has knowledge of the client’s educational background and prior work or volunteer experience.  This return-to-work process includes exploring work in the same or with a different employer in the same or new job with or without modifications.  Often the employer is contacted to discuss the functional capacity based on their physician evaluation.  The RC or case manager would evaluate the job goals and often would consider the physical demands required in the job.  Sometimes a job analysis or more in-depth testing could be needed to help the individual develop their job goals.

“How do case managers perform their job?”

In today’s rapidly changing practice there are seven job functions:  (1)vocational counseling and consultation, (2) counseling interventions, (3) community-based rehabilitation service activities, (4) case management, (5) applied research, (6) assessment, and (7) professional advocacy (Leahy, Fong, Sanders 2003). From this list we see case management as a function of a Rehabilitation counselor’s occupation, which indicated that case management is just a part of what they do or could be considered a specialty within the field of rehabilitation counseling.  In summary, this is interesting, and therefore I selected this topic to research.  to an addiction rehabilitation facility may be necessary.

And Vocational case management requires that a RC has knowledge of the client’s educational background and prior work or volunteer experience.  This return-to-work process includes exploring work in the same or with a different employer in the same or new job with or without modifications.  Often the employer is contacted to discuss the functional capacity based on their physician evaluation.  The RC or case manager would evaluate the job goals and often would consider the physical demands required in the job.  Sometimes a job analysis or more in-depth testing could be needed to help the individual develop their job goals

Rehabilitation Counselors use case management skills is a variety of work settings, including public rehabilitation, private for-profit rehabilitation, behavioral health treatment programs, community-based rehabilitation, private not-for-profit rehabilitation programs and managed care (CMSA,2016; Shaw, Leahy, & Chan, 2005). Case management is also used in hospital and integrated care delivery systems; ambulatory care clinics and community based organizations; corporation; schools, public health insurance and benefits programs; private health insurance programs; government sponsored programs; geriatric service; long-term care; end-of-life, hospice, palliative, and respite care programs; physician and medical groups; life care planning (LCP); as well as health, wellness, prevention, and disease case management programs (CMSA, 2016 p. 14).The expertise of a case manager can also be used in their own lives and their families lives throughout their own life span.

Case managers often are considered voluntary so they must speak directly to the client’s needs and wishes.  Dealing with family issues involving conflicts is common and the case of mental illness client or in the larger geriatric population where it often involves all aspects of care.

Third, there is a process that case managers follow and involves many steps.  There are six primary steps in this process: (1) “client identification, selection and engagement in professional case management” (2)Assessment and opportunity identification (3) development of the case management plan of care (4) implementation and coordination of the case management pan of care; (5) monitoring and evaluation of the case management plan of care and (6) closer of the professional case management services” (CMSA 2016, pp. 18-19).

Implementing these steps, the Rehabilitation Counselor usually receives a referral either directly form the client or from another agency.  This leads to completing an initial assessment and then exploring the clients medical, psychological, and vocational case management needs.  If they are eligible for services, the RC develops a treatment plan and decides with steps are needed to help the client achieve his or her goals.  Often modification is needed throughout the process and a written release of further information by the client may be needed

“Why case management?”

Next, we must understand the value in hiringcase manager which often tend to specialize in one area or field.  RC’ or case managers s often look at health complexities and are good at solving problems or helping individuals going through difficult times in their lives.

“Health complexities are determined by the age of the patient, the number of the chronic illnesses the patient has, with an emphasis on physical disease, and the costs of incurred services”.  (Kathel, Roger).“They do notconsider many other factors like personal and social factors like housing, ethnicity, social support, and financial situations, as well as psychological conditions are also significant factors in determining complexity” (Kathel, Roger).

One way according to Medline Journal article, “There is evidence that case management can be effective in cancer patient quality of life”(ClinicalKey Oct. 2, 2020 Vol. 98, Issue 110).However, they also noted more controlled studies should be provided with detailed information about interventions towards the cancer patients outcomes involving the rehabilitation process.  The geriatric population for example is growing rapidly and more services will have to be provided after illness occurrences.  If we look at a patient with severe mental illness, case managers are a key player. “Frequent conflicts arise between clients’ wishes and the families’ goals, program goals and community goals.  The conflicts create a natural tension that case managers must be continuously monitored so the services are balanced to provide care that is useful and acceptable to the client and will still be supported by the larger community” (Suber, Robert W).

In summary,this proposal has allowed me to understand the role of a case manager, along with their functions, values, and the process which a “case manager” encompasses. I also clearly understand that is can involve many areas including medical, psychological, and vocational.  Andthat there tends to be overlap of care in the case management process.

 

 

 

 

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