Integration, not Duplication: How Case Managers Add Value

Ontario’s CCACs serve well over 600,000 clients annually.  Here in Central West, we serve over 30,000 people each year, many of whom have complex care needs and rely on our skilled case managers to coordinate the care they need.

So I was very disappointed to see Francesca Grosso’s opinion piece in last Thursday’s Toronto Star.  In it, Ms. Grosso states that 40 per cent of the provincial home care budget “is spent by community care access centres on administration and case management to determine whether or not patients are eligible for home care and how much they need.”

To suggest that “case management” and “administration” are interchangeable terms is, without question, misleading.   Case managers are regulated health care professionals – nurses, physiotherapists, occupational therapists, social workers – who bring to their role a distinct knowledge base and clinical expertise.   

The fact is, CCACs spend over 91 cents of every dollar they receive on direct client care, which includes the contributions of case managers.  These expenditures include:

  • moving people out of hospitals when their care needs are most appropriately met in another setting
  • providing clinical assessments and coordinating the individual care people need
  • finding family physicians for over 40,000 people, helping them avoid emergency department visits
  • placing people, as appropriate, in long-term care homes or other supportive programs

When a case manager conducts an assessment, he or she is ensuring that the client’s medical history, care needs, risks and preferences are documented so that care can be provided safely and effectively.  All of this information is shared, securely and electronically, with the appropriate care providers, whether they be providers of services such as nursing, physiotherapy, and personal support, adult day programs, or long-term care homes.

To illustrate the value that CCACs provide, consider a situation in which a loved one is about to be discharged from the hospital with multiple care needs and intravenous medication.  Let’s call him Jim.  It’s an overwhelming, sometimes confusing and often emotional time for Jim’s family, who is unsure of what will happen to his care when he returns home.  That’s when the CCAC steps in to help.

Before Jim even leaves the hospital, Sheila, a CCAC case manager, has worked with Jim, his hospital care team and his family to understand his needs.  She has made arrangements with a pharmacy to ensure that the appropriate medical supplies are sent to Jim’s home, and orders nursing service for him by securely sharing her assessment with a CCAC nursing service provider.  As a result, a nurse with the specialized skills to treat Jim’s conditions arrives at his home.  Sheila’s assessment, which she arrived at through the use of standardized, internationally-recognized tools, has enabled the nurse to deliver timely, efficient and personalized care.  In addition, Sheila has recognized the need for services beyond nursing and has referred Jim to a physiotherapist and a personal support worker who will assist him on his road to recovery.  Finally, Sheila recommends an adult day program and a diabetes clinic in Jim’s community as further supports for him and his family.

Sheila’s work is not merely administrative duplication; rather, it is the work of a highly skilled professional whose comprehensive care plan dramatically reduces the inevitable delays, inefficiencies, and barriers to good care that Jim and his family would have experienced in her absence.   As a case manager, she has taken a holistic view of her client and provided the necessary supports.  She will continue to monitor his progress and the quality of his care over time, helping Jim to heal, maintain his independence and avoid future readmissions to the hospital.  To suggest that she constitutes an “expensive administrative layer” is both insulting and thoroughly inaccurate.

To share more information about how CCACs add value, our sector recently released the 2010-2011 CCAC Quality Report.  If you have the opportunity, I would encourage you to view this important document.  And as always, I welcome your thoughts and comments.


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