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Tuesday, 26 January 2010 15:05 |
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To better understand the intricacies of the consumer direction movement, Richard Scott sits down with Pamela Doty from the Department of Health and Human Services who authored the study New Strategies to Meet Long-Term Care Needs that appeared in an early January issue of Health Affairs.
Can you describe consumer-directed long-term care service programs?
These are service delivery models designed to empower people with chronic disabilities and their families. They gain considerably more choice and control over the who, what, where, when of their home and community-based long-term services and supports than they would have in a more traditional “provider-driven” system.
What do these programs hope to achieve?
The goal is a more flexible service system that is able to be responsive to what service users and families want. We have observed that different constituencies tend to be drawn to consumer direction for somewhat different reasons. For example, among older people, the main motivation is typically that they want to have home care workers whom they know and trust, individuals who know them and their preferences and that they feel comfortable with.
This often means that older people choose consumer direction because this allows them to hire family, friends, and neighbors as their paid caregivers rather than rely on “strangers” from an agency, especially because the evidence indicates that there is much greater turnover among agency workers. Among younger people with disabilities, a major complaint is that the traditional service system is about custodial care (i.e., providing help with personal care and housekeeping tasks as well as protective supervision) instead of promoting independence and enabling them to lead more fulfilling and “self-determined” lives.
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Written by Rebecca Perez, RN, CCM, CPUM
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Tuesday, 15 December 2009 21:02 |
 Merging Physical and Behavioral Health
It’s no secret that the future of health care delivery is somewhat uncertain. While few will disagree that reform is needed, how that will happen is still being debated. Regardless of what reforms are implemented, one thing is certain—case managers will continue to work with patients to improve outcomes.
Before health care became such a huge industry and, now, a burden to the nation’s economic well-being, physicians provided care to patients to improve and maintain overall health. The advent of managed care significantly altered how a physician provided care, resulting in a segregation of care and services that was meant to reduce costs and improve efficiencies. While efficiencies and costs have been better managed, the health and well-being of individuals, especially those who are considered complex, has not fared as well. A complex patient is someone with both physical and psychological issues, and in today’s health care environment the state of physical well-being tends to be addressed more adequately than the psychological state. This segregation has resulted in less than desirable outcomes, increased costs (typically seen in medical utilization), and inadequate utilization of psychological services.
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Written by Vergil L. Metts, PH.D.
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Tuesday, 15 December 2009 20:56 |
 Ask the right questions, listen carefully, and empower clients to choose
Last issue, I cited 10-time NBA championship coach Phil Jackson to illustrate how mediocre players sometimes turn out to be fantastic managers.
At the peril of turning this into a sports column, Jackson’s transformation is worth pursuing when considering the coaching role case managers assume in their daily work—specifically, in the challenges you often face among people wanting you to make decisions that they alone can make for themselves.
As coach, Phil Jackson can’t shoot the ball. But he’s proven legendary at creating an environment for his players to succeed, where their natural talent can flourish and create positive outcomes.
Patients and families under duress, in pressing need to make choices, often turn into players who need to shoot but keep passing the ball back to you. Why? Because stress and uncharted waters can easily short circuit almost anyone’s decision-making apparatus. Through my coaching work I have witnessed famously take-charge executives lose their compass when unexpected events intervene, running in circles instead of reasoning out solutions.
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