Long term care: concepts, challenges, and services

¶ … Management

L. Jones

Basic Principles

In today's world, healthcare is increasingly being administered by a "team approach." This is especially true in long-term and in-patient environments, as well as concerning the care delivered to patients with complex or chronic health conditions. Within this team approach, it is necessary to successfully "manage" all of the components that go into the treatment and care of the patient. This is where the concept of "case management" comes in.

In simple terms, case management is a process of health care. It involves helping the patient find, access, and benefit as much as possible from the medial procedures, treatments, and lifestyle solutions available to his or her particular needs. Further, case management (usually administered under the centralized direction of a case manager), is usually indicated for complex or chronic patients (including those in long-term or geriatric care), in order to insure that their unique and usually complex needs are adequately met. Further, it is also common for those who have unique challenges -- including mental disabilities, financial challenges, social disadvantages, or extremely high medical expenses to qualify for case management services (NNMC, 2004).

Some examples of services that can be coordinated and supported through good case management is the creation of an individualized treatment/care plan, establishment of a connection between the patient and government support or benefits, education aimed at helping the patient manage his or her condition in a positive way, coordination between the many providers often required in complex, chronic or long-term cases, as well as help in scheduling needed treatment or services (NNMC).

Five key steps in the practice of case management include assessment, planning and establishment of a treatment plan, coordination of services, evaluation of special assistance needs, and continued monitoring of the patient's needs throughout the patient's care (OCMO, 2004). These not only reflect the goals of the concept of case management -- namely the continued support of long-term, complex, or chronic cases, but also reflect the unique needs of the patients who qualify for or require case management services.

The simple fact is, particularly in long-term care situations, case management services are of particular importance. This is because long-term patients typically require a vast array of services and professionals while at the same time are uniquely unable to care independently for themselves. In specific, the very definition of long-term care refers to "a broad range of supportive medical, personal and social services needed by people who are unable to meet their basic living needs for an extended period of time. This may be caused by accident, illness or frailty (Day, 2004).

Because people in need of long-term care require such extensive supportive, social, and medical services -- so much so that they may need everything from help with movement, basic self-care and living tasks (eating, dressing, bathing, toileting), as well as medical care, transportation, financial assistance, etc., they often desperately need someone to coordinate their varied needs. Thus, the efforts of a case manager are highly indicated.

Community Care Program for the Elderly and Disabled (CCPED)

CCPED provides home and community-based services for Medicaid-eligible persons who are 65 years of age or older, or persons of any age who are disabled. In addition to traditional home health care services, medical day care, medical transportation, respite care and social adult day care are available. Homemaker services are available 7 days. Hours are determined by a case manager (nurse or social worker) who completes an individualized care plan and budget for each client. Case managers are responsible for assessment of need, placement and monitoring of services, and advocacy for their clients.

Of course, many people are interested to know just how a "typical" case management situation involving a long-term patient might be conducted. Consider for example the Home Care Expansion Program (HCEP), located in Central Jersey. In the program:

case management services are provided for persons aged 65 or over who meet financial and other criteria established by the Department of Human Services. Services may include homemaker, visiting nurse, home health aide, physical therapy, occupational therapy, speech pathology, respite services, social work and Medicaid transportation, according to the needs of each individual (VNACJ, 2004).