By: Dominick L. Flarey, Ph.D, RN-BC, ANP-BC, NEA-BC, FACHE
       Board Certified, Adult Nurse Practitioner
       Board Certified, Nurse Executive Advanced
       Fellow, The American College of Health Care Executives

In today’s health care system, case management is becoming an increasingly important way to ensure quality care for long-term health care patients. Case management is a process that involves a team of health care professionals, who work together to coordinate and provide comprehensive care for patients with long-term health care needs. This team of professionals is responsible for assessing a patient’s medical needs, developing a care plan, and monitoring the patient’s progress. Case management has numerous benefits, from reducing hospitalizations and emergency room visits to improving overall quality of life. It also helps to reduce costs, as case managers can ensure that patients receive the most appropriate and cost-effective care. By exploring the benefits of case management in long-term health care, we can better understand how it can help improve patient outcomes and reduce costs.

What is Case Management?

Case management is a process that involves a team of health care professionals, who work together to coordinate and provide comprehensive care for patients with long-term health care needs. Rather than having health care providers treat specific issues, case managers consider the entire individual and how different aspects of their care are related. This team is responsible for assessing a patient’s medical needs, developing a care plan, and monitoring the patient’s progress. Case management has been used in different areas of healthcare for some time, but in recent years, it has also gained prevalence in long-term care. This type of care typically involves a combination of services, such as nursing, pharmaceutical, social work, and rehabilitation. Long-term care services are generally needed by individuals who have a chronic illness or disability that requires ongoing care.

Long-Term Care

Long-term care is an interdisciplinary field of health care encompassing a range of services and supports for individuals who are chronically ill or have a disability. This type of care is used to provide assistance with activities of daily living such as bathing, dressing, grooming, and eating, as well as instrumental activities like housekeeping, shopping, and managing finances. Long-term care can be provided at home or in other settings such as adult day programs, assisted living facilities and nursing homes.

Benefits of Case Management

Case management has numerous benefits, from reducing hospitalizations and emergency room visits to improving overall quality of life. In exploring the benefits of case management in long term care today, it also helps to reduce costs, as case managers can ensure that patients receive the most appropriate and cost-effective care. By exploring the benefits of case management in long-term health care, we can better understand how it can help improve patient outcomes and reduce costs: 1). Reduced Hospitalizations and Emergency Room Visits, when patients receive coordinated and comprehensive care, they may spend less time in the hospital, as well as in the ER. This is particularly true for patients with chronic illnesses and/or long-term care patients. 2). Ensures greater quality of care, due to the interdisciplinary approach of case management, patients are often provided with more thorough care. This can help to ensure that each aspect of the patient’s care is addressed, which can ultimately improve overall quality of life. 3). Case Management in Long-Term Health Care, one of the primary ways in which case management is used in long-term health care is to help provide an ongoing assessment of a patient’s care, as well as their needs. 4). Provides for a more collaborate approach to long-term care delivery, long-term health care has traditionally been managed by physicians, who have been responsible for both diagnosis and treatment. With the implementation of case management, however, other types of health care professionals, such as nurses and social workers, are also able to provide care. This helps to provide a more interdisciplinary, collaborative approach to long-term care delivery.

Helps to improve patient outcomes

Case Management is also known as care coordination and/or care management. When individuals in long-term care are involved in case management, there is a potential for improvement in their overall health outcomes. Patients in long-term care who participate in case management are more likely to receive the medical care and services that they need. This could include medications, nutrition therapy, or specialized therapies such as physical therapy. People in long-term care who receive the services that they need may experience better outcomes in terms of their mental health. This may include a reduction in feelings of depression, anxiety, and/or feelings of isolation. People in long-term care who receive the services that they need may experience better outcomes in terms of their ability to live independently. This may include a reduction in the amount of assistance needed to perform daily living tasks, such as bathing or eating.

Challenges of Case Management

While case management offers many benefits, it is important to note that it is not a cure-all for the challenges that exist in today’s long-term health care system. One challenge is that not every patient who needs long-term care has access to it. Although long-term health care is becoming increasingly common, there are still not enough resources available to meet current needs. There is also not enough consistency in the services offered throughout the long-term health care system, as there are many different types of providers, who offer long-term care. This means that patients and families may not receive the same level of care from one provider as another. Another challenge of case management is that it is not always the best option for all patients. While it can be beneficial, it is not appropriate for everyone. This can make it more challenging to identify patients who will benefit from case management services.

Conclusion

Case management is a growing trend in long-term health care, as it offers numerous benefits and helps to improve outcomes. Although it is not a cure-all, it can help to improve the quality of care patients receive and reduce costs. While challenges remain, case management remains a promising way to improve long-term health care.

Education and Certification in Case Management

Are you a registered nurse, social worker or a health care professional who is interested in case management? If so, the American Academy of Case Management offers a unique, online curriculum of core courses that leads to a full Certification and Fellowship Status in the Academy. You may access this link for full information on the program. Courses are continuing education courses with Board approvals and may be taken one course at a time until completion. All of the courses are online with faculty mentoring as needed and there are no travel requirements. Any questions may be addresses to: info@aihcp.org

Suggested Readings

1. Can post-exposure prophylaxis for COVID-19 be considered as an outbreak response strategy in long-term care hospitals? Sun Hee Lee, et.al. International Journal of Antimicrobial Agents. Vol. 55(6): June 2020. access here.

2. Case management in capitated long-term care. Rick T. Zadwaski, Catherine Eng. Health Care Finance Review. National Library of Medicine. December 1988. access here.

3. What Does “Managed Long Term Care Service” Mean in the United States? A Concept Analysis From a Case Manager’s Perspective. Kyungmi,Woo, et.al. Home Health Care Management & Practice. Vol.33(3):November 7, 2020. access here.

4. What do we (still) need to know about long-term care management? Howard B. Degenholtz. Generations Journal. American Society on Aging. Spring 2021. access here