Presented by Lorraine Poulos Professionalising Case Management 1

Acknowledgement of traditional owners Background to presentation Current environment – aged/disabilities/health/childcare moving to a consumer driven human services where funding follows consumer Moving to a ‘user pay’ system 2

Implications for Case Managers in changing environments The importance of intermediaries Consumer preferences Positioning Infrastructure and costs Culture and readiness Lorraine Poulos and Associates 3

Identified skills 4 The Community Services and Health Industry Skills Council environmental scan 2013/14: Case management Care planning Financial management Leadership skills Australian Aged Care Quality Agency INA 2014 confirmed these with the addition of CDC- budgets, choice, enablement Quality Customer service Consumer engagement Identifying and managing risk

Current state of play 5 Case Management service type out of CHSP – why ? RAS- short term re-ablement case management in model – early days NDIS –planners CDC – consumers questioning value of ‘Case Management’ Confusion over what it means- co-ordination, rostering, short term/joint/ long term

Why misunderstanding or lack of ‘value’ 6 Case Management unable to be ‘defined’ by those actually doing it ! Use of jargon when describing to clients particularly those who can self manage Poor documentation and evidence of timely interventions/support e.g. mental health, aged care Very poor skills in marketing services and benefits, lack of research/evidence

7 All resulting in a reduction in the ratio of Case Managers to clients

Case Management – CMSA definitions case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s holistic needs through communication and available resources to promote quality cost-effective outcomes. CMSA, National Standards of Practice for Case Management, 3rd Edition

Case Management – CMSA definitions Case Management is a process, encompassing a culmination of consecutive collaborative phases, that assist Clients to access available and relevant resources necessary for the Client to attain their identified goals. Key phases within the case management process include: Client identification (screening), assessment, stratifying risk, planning, implementation (care coordination), monitoring, transitioning and evaluation. Within the case management process the Case Manager navigates each phase of the case management process (as applicable) with careful consideration of the client's individual, diverse and special needs, including aspirations, choices, expectations, motivations, preferences and values, and available resources, services and supports.’ CMSA, National Standards of Practice for Case Management, 3rd Edition

Key phases within the case management process include: client identification (screening) assessment stratifying risk planning implementation (care coordination) monitoring transitioning and evaluation 10

Case Management within Human Service delivery 11 Case Management, as it is understood by professionals, promotes clients to self manage as much as possible whilst stratifying, evaluating risk and barriers to clients achieving goals – (social and health determinants)

Case Management Concepts FACILITATES the personal development of Clients ADVOCATES for Client rights. is PURPOSEFUL PROMOTES sustainable solutions. is underpinned by COMMUNICATION CMSA, National Standards of Practice for Case Management, 3rd Edition

Professional training provided to Case Managers via CMSA 13 Case Management Society of Australia CMSA – competency training in National Standard and Code of Ethics National Skills Set for Effective Case Management Certification process – National Register and data base Organisations identifying lack of evidence of skills in documentation via pre and post QR and TPV audits

What are the skills set ? 14 Advocacy Care planning including measurable goal setting Case conferencing Communication – written and verbal Cultural sensitivity Documentation Financial acumen Interviewing and assessment Networking and collaboration

Some documentation requirements Assessments relevant to client/consumer need Care plans Budget discussions (if relevant) Progress notes Appointments Reports Referral reports Phone calls Review of the case management practitioner or professional actions i.e. advice, support, linking, promotion of independence etcetera 15

16 Why Should I Care? It is the law Case notes can be subpoenaed as evidence in court cases Clients (or the person they appoint) have a legal right to access their personal records and read what you have documented Your organisation’s contract with the funding body legally requires you to comply with specific Standards What you document will impact on the quality and accuracy of a client’s care and the quality and accuracy of communication with other stakeholders Efficient and detailed case notes provide case management practitioners and professionals with greater legal protection and accountability in practice. Conversely, they serve to prompt the recall of memories (i.e. information and events and actions) if required at a future date or court proceeding 16

Incorrect Documentation 17 Statements which are judgmental and subjective Incomplete entries No signature or designation Inaccurate Not dated Important information missing Spaces allowing for corrections or changes Hard to follow Inappropriate opinions, labels, personal judgement or value laden language that is open to personal interpretation

18 What are the clients abilities? What will the service do? What will the case management practitioner or professional do? When/How will the case management practitioner or professional review the achievement or progress? Goal and Care Plan

Purpose of a Case Conference 19 Inter-multi-disciplinary group process convened to review a care plan A professional forum to share and exchange information Meet and collaborate with other key stakeholders involved with the client and/or their significant other Define, identify and/or clarify roles, tasks and functions of all key stakeholders Receive updates from key stakeholders Clarify information or concerns from the client and/or their significant other and/or key stakeholders Review existing goals, interventions and progress Future planning and delegation of tasks

Other matters Lorraine Poulos and Associates 20 Case management/core advisory need to be ‘articulated’ on care plans in a meaningful format Financial conversations Meaningful solutions Assistive technologies Culture change Fixed cost and variable incomes- case management suffers

Other matters Lorraine Poulos and Associates 21 Case scenario planning – 50% occupancy Marketing – needs to ‘sell’ case management NDIS and CDC – empowered consumers LOVING it ! Home Care today/ NDIS – information for consumers about case management/core advisory Examples of little or no evidence in files of co-ordination or case management No system of reviewing files for accuracy and contemporaneous notes Training expensive Financial skills of staff

22 If we are ‘Case Managing’ we need: Evidence of all skills via training Confidence in our abilities Specialist skill development e.g. dementia, youth issues, restorative care, clinical care Understand the clients right to choose – dignity of risk/duty of care balances (see Home Care Today website resource)

Informed and empowered clients may choose to NOT have our case management services! 23 attitudes are the real disability

24 Thank You Further details contact Lorraine Poulos and Associates