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Question of Month

What is a Case Manager?

What is a Case Manager? Our first task is to help all of us define what a case manager is? We need all to comment on what they think a case manager is. Then we will summarize how we define it. We want to make this an interactive learning process so please comment!! - Sample things to consider? What type of "case managers" have you heardof? What settings have you heard that term used? What special licensing have you heard associated with "case managers" Separate from licensing what actual skills do you think a case manager needs? What does or could a case manager do for you? Doctor, or  Nurse, Or Social Worker, Or Hospital employee, or... There is no job, or single training the clearly is better than any other   What you need is a high amount of training and active practice in all of the above areas in all care settings, hospital, rehab out patient and the many types of inpatient rehab, Assisted Care settings, Home Care, Private Case management, all of the allied care settings, cosmetic and less medical but widely used and needed care, emotional health out patient and inpatient, and many others.  Add in specialization in chronic illness and Geriatrics.  Needless to say few people have that training.  I consider myself fortunate to have most of those care experiences.  While most nurses are not doctors I have done a lot of direct nursing care and care giving while caring for my own parents.  I do hands on care with residents all the time.  I have had patients say don't help me with that you are the Doctor. In the end every one is a doctor and every one is a patient, like patch Adams says we all help each other doing what we can, even listening is a job.   Case manager is a term with no definition, no expectations, since we know of know standard for that term. Many will claim to be case managers.  There are two main kinds.  Those that manage your case but work for the hospital ,  institution, Assisted Living Facility, Home Care, Hospice Care businesses and those that you pay with your private dollars.  Of course, I am very biased as a Geriatric Specialist who has worked in all long term care settings, has worked in private case management not as the person who asked the doctor what to do but as the doctor who knows what is needed and what is cost effective.  My view is very biased.  Indeed, I recall many times when a private pay case manager called me and suggested something that had no medical benefit.  I did see the benefit to her in that she most likely needed to show her clients she was worth the $250 per hour she was being paid.  Needless to say I did not feel her comments were needed.  I do also have to say that case managers often times do know more about private pay home care and many outpatient services that most doctors have never heard of and if that is the comparison then they can help.  Either Case manager or Doctor Case manager if the person does not do some direct care, spend physical time with the senior, their family and the care giver staff the benefit of their knowledge and skills are reduced significantly.  Continuity of Care is good Care, the Best Care.   The golden rule applies again.  Meet the entire care team you are getting from the top management, the doctor, administrator, middle skill people the nurses and other professionals and then the caregivers.  The people provide the care.  You need a doctor or team leader who knows the patient but also all of the staff since continuity of care requires a team approach.  That is a team approach in practice and not only on paper. By Shawn McGivney MD, RFA Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List:   Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/    

Case Manager Corner – Initial

Case Manager Corner - Initial Case manager corner. We provide unique views and insight to topics that you would otherwise not get. In addition, to more detailed discussions of topics on the free blog we cover two additional strings that help the reader interface and apply the theory we discuss on the free blog. Those two sections are Myths and miss conceptions and Case manager corner. With the loss of continuity of care and the decline of the old fashioned “doctor” who knew your case in depth, followed you in all care settings and in the health care system in general, all of us are increasingly called upon to manager our own cases and to be “case managers” for ourselves and our loved ones. We offer a discussion string called Case manager corner in which we help each of you become a more informed case manager for yourself. Continuity of care requires each of us to become more involved in our own care. It requires each party, doctor, family, patient, and caregivers, facility administrator and others involved in our care to value the other member’s contributions. Only by asking yourself how the other people feel can you expect continuity of care from them. However, in the end each individual or family needs to make the final decision of what they need, want, and the best, most cost effective, way to achieve it. Case manager corner is our moderated discussion on ways each of us can be our own case manager. Now when much of the continuity in care has been lost from that traditional doctor patient relationship now more than ever we all need to be our own case managers. Join now to see if we all use the term “case manager” with the same meanings and expectations. In the end we all are our own case managers.  While you doctor could be a big asset in managing your case, many doctors unfortunately have little geriatrics and out patient care, chronic care, senior out patient care experience.  Many are less familiar with the Senior Care Continuum which includes Assisted Living, Residential Care Homes, Home Care, Nursing Homes, Hospice Care, Respite Care, Adult Day Care, Elder Care and many other variations of care. Membership and education are a great value. We believe our members section pays for itself if you use even one idea to improve your own personal use of your existing health care system. For example if you are choosing and Assisted Living or comparable care setting you can expect to pay 2, 000 a month or more. This difficult and expensive choice is equivalent to buying a new car every year. We want everyone to compare the “ASSISTANCE” they are paying for when they pay 2 – 4000 a month for care or “assistance”. By reading and participating in our members area you will gain a better, broader, understanding of what is available, what questions to ask, when looking for the care and continuity in care, with the “assistance” you want. Members get more in depth discussions on the topics covered on the free part of the site. Members get access to more specific case scenarios with more detailed suggestions for solutions and ways to approach the various questions posed by our members. Members get access to ideas and methods to interact with the health care system including ways to better utilize existing insurances and drug plans Members get two unique posts twice a month under Myths and misconceptions and Case manager corner that are not posted on the free part of the site. Members get access to an insurance comparison and discussion section that compares and contrasts various insurance options. Under case manager corner one topic is choosing your insurance. Our comparison includes the member’s comments and moderated answers to give a patient and family centered view of what each plan offers. We also include cash or having no insurance as an alternative that many do not include. For example, many may not know it may be cheaper to pay cash for your medication than to use your insurance and pay only the co pay. That is right, if you pay cash it might cost less than the co pay on your insurance. Members get access to special video interview with guests on special topics. Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List:   Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/  

Myths and Misconceptions – Initial Post

Myths and Misconceptions: We provide unique views and insight to topics that you would otherwise not get. In addition, to more detailed discussions of topics on the free blog we cover two additional strings that help the reader interface and apply the theory we discuss on the free blog. Those two sections are Myths and miss conceptions and Case manager corner. Myths and misconceptions. Myths and miss conceptions is about alerting and educating you to be cautious on how you hear and understand many of the terms used in health care. Misleading words might include “Assisted Living”, “Normal”, or Needed and “Not Needed”. A second, set of misleading items are numbers like we pay 80% or even 100%. Sign up now to learn why in some cases you may not want the one that pays 100%. For example, many may not realize how something as simple as mis understanding the definition of “Assisted Living” might affect your decision of which care setting is best for you. We help you see beyond the mere definition of “Assisted Living” which will mean different things to each person when you quantify what you get, from whom, at what time and at what dollar cost. The facility offering the amount, degree and type of assistance might not value or define the amount, degree, type, or timing of the “Assistance” as you do. We help residents and families see beyond the words to help them better access and compare types of assistance. Through discussion with families, other members, we help members reevaluate what they think they need, want, and is available to them when making this difficult choice. We emphasize high quality care requires a relationship with the people providing the care. We believe continuity of care is a necessity to each resident and family valuing the Assistance as high quality assistance. The more continuity of care the better the resident will feel about the care. We feel that by considering continuity of care, the care you get will be of higher quality and more of the care we think people expect when they define the word “Assistance”. If you just learn how the doctor, insurance company, lawyers, advertisers and others define the same words you use you will be more informed when you hear them. Words and phrases like “You must leave or you must go to a nursing home may not mean “must” if you decide to choose something else. We want to help everyone see choices that they may be passing up today.   These Medical myths and misconceptions are common in all care settings including Assisted Living, Residential Care Homes, Hospice Care, Home Care, Dementia Care, Alzheimer's Care, Memory Care, Nursing Home Care, Elder Care, Respite Care and Adult Day Care.  Knowing what you and the other person mean when they use a term helps you understand what both of you will expect. Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List:   Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/  

Continuity of Care – power point presentation 08 06 12 must read.

Continuity of care (08 06 12) I just read a good power point pdf by Dr James Birch MD, MSPH and wanted to share it with all of you. http://www2.kumc.edu/coa/Education/AMED900/CONTINUITY%20OF%20CARE.pdf It is a 60 page power point slide presentation and reads just like you are turning pages. He has many great statistics to confirm that continuity of care improves out comes especially for seniors with many complex medical issues. As Senior Care advocate those reading this blog will be part of the plan to remedy the loss of continuity of care seen in the doctor related medical community.  Indeed, much of the continuity of care that use to be done by the residents doctor now falls to Administrators, care givers and those providing protective supervision to residents who need varied amounts of “assistance”.    Care setting directors need to maintain close contact with the wide range of sub specialized medical providers to ensure that medical information and orders are carried out on behalf of the residents they are providing protective supervision to.  Indeed, the PCP,  might not know what the sub specialist said or ordered on the residents last visit,  so we need to remain in contact with all medical providers on behalf of those we provide protective supervision to. Finding, care settings that have a higher level of administrator and owner continuity of care can be a way families help bridge the growing loss in continuity of care seen within the health care system in general.  We would like to work with providers to help build a directory that lists care settings and includes continuity of care with administrators, owners, other professionals, caregivers and others.   Some of the variables we might compare are Administrator / resident ratio, hours of direct resident contact each month with the administrator or owner, consistency of staff providing care to any individual resident and other variables bloggers might suggest.  We want to help people see the value of continuity of care that Dr James Birch MD, MSPH illustrated in his presentation. Thanks for reading this post .  If you liked this post please help us by sharing the message of Care, Caring, and Continuity of Care by likeing, friending, and following our works on Facebook     (tlcsr.kerrymcgivney), Twitter ( TLCSRLasVegas), Youtube (TLCSRLV),  Joining our Email List and this Blog, and sending this to any sons, daughters, or seniors you know. Here are links to make it easy! Like Our FaceBook Page: Friend Us On FaceBook: Follow us on Twitter: Like our videos on Youtube: Join our Free Blog and Email List: Contact: Shawn McGivney MD, RFA [email protected] www.tlcsr.com www.tlcsr.com/blog/

OUR GOLDEN RULE

OUR GOLDEN RULE: The first and most important thing to remember is what we call our Golden Rule: Meet as many of the people who will be providing the actual day to day care as possible. That’s right…. it is so important to meet the actual people who will be responsible for the care or assistance given, that includes the Administrator, Owner, Caregivers, Med techs, Doctors, Nurses, Kitchen staff and Cleaning staff etc. It is the people and staff that matter the most since they provide the services you get. The physical setting of the building is also something to consider, but the main focus should be on the people. It may sound overwhelming to ask to meet and speak to all these people, but if the facility makes it easy for you to meet and interact them in the beginning, then there is a very good chance you and your loved one will be able to have access to these people as time goes on. On the other hand, if it is difficult for the facility to coordinate between themselves and make themselves available to you from the first day, then that may be a good indicator that you and your loved one will continue to have a hard time finding people and getting things done when you really need them. Many facilities focus on their marketing and sales by focusing on all the luxury items, private rooms with private baths, hair salons, pools etc., but may say very little about what we believe you really need, want or desire… which is care, caring and continuity of care. Subscribe for free to comment and share your stories with us. We are an interactive blog and need feed back to illustrate and describe the many variations, choices, approaches, and outcomes to help other readers. Dr Shawn McGivney Free Ways To Help

Introduction to Senior Care Alternative Choices

Introduction to Senior Care Alternative Choices In today's health system we are often lured with the words “quick care” or “urgent care” to describe the type of care we receive. In fact, what we need is continuity of care. Continuity promotes complete care and quality care. Imagine how your experience in health care might be different if you saw the same doctor, nurse, or caregiver every day instead of seeing a different care giver each day. Indeed, if you are young and have just one problem seeing a different provider might make less difference since there is little history to uncover each time. In general, young people have one problem and do not have a long complex medical, social, financial and emotional health history. On the other hand, seniors and those with chronic disease, have a life time of problems that are usually progressive and changing as they age. When you choose a senior care setting for a loved one who needs minimal care today, be sure to consider continuity of care, and what needs they will have in the future. For seniors, there are only a handful of alternative Senior Care options. Assisted Living facilities, Residential Care Homes, Home care and nursing homes are the options available. There is a lot to consider BEFORE making that expensive and life altering decision of which senior care setting is best for you, not just for the resident or senior, but for the entire multi- generational family. In all cases, it is the people who are doing the work, day in and day out, they are the ones that play a large part in determining the quality of facility. Senior Care Assistance is a service. The quality and continuity of the service is very dependent on the management, administration and entire staff. Does each of these people have direct and frequent contact with the residents and families? Moreover, we want to emphasize that this is an expensive choice, no matter what you choose Independent Living, Home Care, Residential Care Homes, Assisted Living, or Nursing Home. It can cost $3,000-$7000 a month or $36,000- 84,000 per year, if not more. The costs can go up depending on the setting and the level of assistance needed. That is like getting a new car every year, so we strongly urge you to consider what you really want and need, when making this expensive choice. When choosing any type of assisted care you need to include the fact that it is likely that you will need more care as time goes on. You need to be sure that the care setting care practically provide what they say they can. We also want to note that this choice affects the entire family. When hospital or doctor’s visits occur, in general, it is the family who has to supervise those complex and changing parts of many senior care settings. Only by having the highest continuity of care, can the family receive the support to make sense of the confusion and frustration that is increasingly occurring in the health care system. Each family member must visit several care settings and ask a few standard questions. When a senior, considering Assisted Living, actually starts down the road of needing even a small amount of assistance, Continuity of Care becomes the number one issue. Remember, Continuity of Care is a person or a team of people keeping track and knowing what is happening to a person at all times; whether it is relating what happened on a doctor visit, what the family members say on each visit, who visited or emailed most recently and how a resident is feeling day to day. Continuity of care can continue out of the Assisted Living setting when a senior goes to the doctor’s office or to the hospital. Providing Continuity of Care in all care, physical, emotional and social care provides the highest level of emotional health and well- being. Things to Consider -Can you have the best care or high quality care, if you do not know or recognize the person providing the care? -Does a facility have multiple employees? How can you know which employee you will get on any given day? If you do not know who you are getting, how can you know what you are getting in terms of care? -We believe that providing care requires having a relationship, even professional relationships. We believe that both sides have to earn and develop trust, which contributes strongly to both sides valuing the quality of care received. We agree with the notion stated by Patch Adams (played by Robin Williams in the movie “Patch”) “ if you treat disease you win or lose, but if you treat the person you win every time.” Please subscribe for free and comment or share your stories with us. check out -- What is the Senior Care Continuum Search Tool? tab a good tool to assist you in your search. Dr Shawn McGivney

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