Case management is the process of assessing, planning, implementing, and evaluating the care of clients with complex needs. It is a collaborative process that involves working with clients and their families, as well as other professionals, to develop a plan of care. Traditionally Social Workers within a local authority act as Case Managers whether this is on a short-term basis such as in an older adult setting or on a longer-term basis for example in a disabilities team. Alternatively in the private sector, case managers are generally medical practitioners, nurses and occupational therapists, who work alongside legal professionals supporting individuals and their families who have sustained life-changing injuries. With no end to the social care crisis in the UK in sight and with continued financial pressures increasing on both families and deputies for low-intensity clients, such as those living in nursing and residential care homes, of which a majority of client's case management is being left to care home /domiciliary care managers. This is either through the "when required" model used by local authorities that a Social Worker (or assistant) will review only if a change in need is identified by the care home or due to the client being self-funding and the local authority not being a stakeholder in their care. Either way, we see clients receiving care but receiving none of the benefits of good case management, impacting their health and social care outcomes as well as their finances with them paying for unnecessary care provisions or needs going unmet requiring more intense care later on.
What is social care case management? Social care case management is a way of providing social care services to clients that ensures that they receive a coordinated and individualized care plan. This type of care is typically provided by social workers, nurses or case management companies, and it aims to provide clients with the support they need to live as independently as possible. Case management typically involves working with clients to assess their needs, develop a care plan, and coordinate services (broker). It also includes monitoring clients to ensure that they are receiving the services they need and that the care plan is working. A simple four-stage model of Assess, Plan, Organise, Review. For those with professional case management provision, this continuous support and review ensure that changing needs are quickly identified, care plans adjusted and new care organised. This can then in a reduction in care due to an improvement in a client's abilities or an increase in care due to a decrease in their abilities. Without this continuous reviewing process, we see needs changing and care plans remaining stagnant resulting in a decline in health and social care outcomes and in some cases an increase in admission to hospitals. In some instances, this lack of continuous management and review of clients has seen a "revolving door" of the hospital to home to hospital. The benefits of social care case management There are many benefits to social care case management, including Improved communication between professionals and clients this includes statutory services such as the NHS and Local Authorities as well as third sector organisations such as charities as well as private sector providers such as professional deputies. Good case management ensures a flow of communication between all stakeholders, the individual and their family. For the client, having the knowledge they have an independent advocate in their case management can not only empower them with their advocate ensuring their voice is heard but also reassure them that they have independent support. Case management allows for greater coordination of care and Increased continuity of care with needs being reviewed on a regular basis and communication with care providers being more efficient this ensures that any changes in needs can be identified and new provision put in place as quickly as possible. For those living in care homes and residential homes, this continuous review can result in small changes such as identification and organisation of new clothing or equipment such as TV's and dementia-friendly radios to larger changes such as the need for a move to alternative providers such as a nursing home due to changes in need. In many case speed is important, the faster a change in need is identified and the more open the communication channels with decision makers such as financial deputies results in the identified need being met in time for it to have a non-detrimental effect on the client. Delays in needs being met, whether this is through lack of identification of need poor communication or, waiting for statutory services all run the risk of poor outcomes for a client and ultimately effects their lifestyle and potentially health. The right case management resolves these issues. The challenges of social care case management Despite the many benefits of social care case management, there are also some challenges that need to be considered, including: -The risk of over-medicalising social problems -The need for extra training for professionals -The possibility of increasing client dependency -The need for careful monitoring and evaluation. While for those clients with intense medical needs, such as those who have suffered severe personal injury, a professional medical practitioner is potentially best suited to organising and managing care provision. Although as with any care planning exercise, care planning should remain a client-focussed and multi-disciplinary affair to ensure a clients needs are met holistically. with those lower intensity need clients, and those with greater social care needs a Social Worker is better suited to lead the case management provision to ensure a non-medicalised person-centred approach is taken. For those receiving care that is not traditionally managed through case management such as those living with dementia, costs are one of the largest challenges being faced. When we look at the cost of domiciliary and residential/nursing care costs adding in case management fees almost seems unfeasible, with the assumption that a domiciliary manager or care home manager will fulfil these roles. However, for families and deputies case management can ensure that assessed needs are met in the best way for the client, this can in some cases result in either alternative provision or a reduction in care being needed. Additionally the continuous reviewing process of case management services ensures changes of needs are identified quickly resulting in less chance of needing crisis interventions which again can be expensive. The future of social care case management Despite the challenges, social care case management is an important part of the future of health and social care. With an ageing population and increasing numbers of people living with long-term conditions, the need for coordinated and continuous care is only going to increase. The traditional model for those non-traditional clients, such as those living with dementia, is not a practical option due to expense and intensity of the provision. However when we look at different models, the subscription model allows for a financially viable, person-centred approach that allows a bespoke service dependent upon the individuals needs and situation. Nellie+ was designed to ensure that the future of case management for clients such as those in care homes receive the same level of support as those with traditional case management providers allowing for improved communication with all stake holders and improvements in quality of life for the individual as well as adding an additional layer of safeguarding. With pressures being placed on deputies to ensure funds are spent appropriately and a legal requirement for ongoing review of a clients abilities and capacity, the traditional model of an hourly rate can quickly become expensive. The subscription model allows for these required assessments and reviews to be built in and the costs spread over an extended period. ensuring a continuous review of the clients abilities and needs as well as their capacity when needed, additionally it also places the responsibility of ensuring these reports are completed on the case management provider and results in legal teams not having to organise periodic reviews, freeing them up to support additional clients. There are reportedly 400,000 people currently awaiting a Care Assessment in England by their local authority, with local authorities struggling to employ registered Social Workers, funding likely to be cut in the future and current work force issues this figure is only going to increase. While a subscription model is not going to be the right service for all clients, those clients with high intensity needs will continue to need a traditional model of case management, those clients that make up some of this 400,000 que, the self-funding clients receiving domiciliary care and those living in residential / nursing care would benefit with continuous review, advocacy and increased communication with stakeholders. Conclusion Social care case management is a vital part of the health and social care system. It can help to improve communication, coordination, and continuity of care, as well as the quality of care. However, it is important to be aware of the challenges that social care case management can pose, and to have a plan for addressing them. For professional deputies and families alike the right type of case management ensures a good flow of communication and ensures funds are spent appropriately meeting the clients assessed needs in a timely fashion. The traditional model of case management for those living with high intense needs is likely to be unchanged however for those non-traditional clients living with illnesses such as dementia the subscription model allows the support and advocacy of traditional case management with a set monthly cost.