By Anita Pascoe, Registered Case Manager and Clinical Lead, West Country Case Management
“What is a case manager?” and “What will a case manager do for me?” are questions commonly asked by a person seeking case-management support for the first time. Most people will not encounter a case manager until they or a loved one have survived a life-changing injury or illness, and most will not know the benefits of having a case manager assigned.
Case managers usually have a background in health or social care, and many will have trained as a therapist, nurse, social worker or similar. As of last year, the Institute of Registered Case Managers (IRCM) maintains a public register of Registered Case Managers who have demonstrated their eligibility and committed to practicing in line with the standards set by the IRCM. Case managers are more commonly found in the private sector but are also growing in numbers within the NHS services.
Surviving a life-changing injury is the beginning of an often long and challenging journey. Most people would have been going about their lives when an unexpected event occurred which altered their life course. For the person and their family this can be likened to being dropped into a desert with no map or compass. Everything is new, there are many challenges to overcome, and it is unclear when the end will be in sight. It can be confusing, terrifying and traumatic for all who end up in this position. A case manager cannot walk in the shoes of their clients, or overcome all of their challenges for them, but they can walk alongside them, offering expert guidance, planning for what to expect, managing risk and removing barriers along the way.
A real-life example of this is the time I met a young man who had survived a car accident. He had spent four weeks in a coma with life threatening and life changing injuries. His family approached a solicitor, who started the litigation process and involved the car driver’s insurer, who approved funding for case management delivered by me. Around eight weeks after the accident, I gathered information I needed from the ward team and began to plan his rehabilitation beyond the ward.
I identified an appropriate unit for more specialist rehabilitation and negotiated funding. He was transferred there and stayed for several months. I then started to plan his discharge back home almost as soon as he was admitted, as there was much to organise in terms of accommodation, equipment, ongoing medical and therapy needs, and a substantial level of care.
After a move to a slower stream unit closer to home, I collaborated with the client and his family to identify, purchase and adapt a long-term home. I also helped to plan his move there, including furnishing it, setting up the utilities and putting together a 24-hr care team.
My client moved in and carers supported him to establish a routine and regular activities. He has since bought a pet cat and takes a holiday abroad every year, with carers accompanying him.
Nearly 20 years on, I am no longer his case manager, but he has remained within our service ever since, due to his lifelong needs. During that time has had only three different people fulfilling the case manager role, so we know him and his needs very well.
While there are now far fewer case managers working in statutory services, I am hopeful that the landscape will change with the recent publication of the NICE (National Institute for Health and Care Excellence) guidance on rehabilitation for chronic neurological disorders including acquired brain injury, which recommends case management at three different levels according to the complexity of needs.
From my own experience, this is the standard we should strive for. A professional with specialist knowledge of conditions, services, funding streams and the relevant laws can have a positive impact on outcomes and prevent people from falling through gaps when moving through multiple services. Additionally, their co-ordination and planning role can result in smoother transitions and less anxiety and distress for clients and their families.
A case manager is a constant presence, moving with a person through various parts of their rehabilitation and taking with them the historical and condition knowledge. It is a privilege to play that role, and while there are many complexities and barriers to overcome, it is an inspiring position to be in, as we are able to see what is possible for human beings to survive and overcome, given the time, opportunities and right support to do so.
Anita Pascoe BSc (Hons) MRCOT
Registered Case Manager & BABICM Fellow
Anita is clinical lead for Westcountry Case Management, part of the Active Care Group Case Management division. She has been a case manager since 2004.
She will speak at Neuro Rehab on Thursday, March 26.