What You Need to Know – Before Hiring a Case Manager
By Linda Ziac
April 10, 2017
The Caregiver Resource Center
What you don’t know about case managers can be costly.
It may surprise you to know, that in the state of CT, there are no state license or certification requirements for a person working as a case manager or geriatric care manager.
As a result in CT, anyone regardless of whether they have any education, training or experience in the health or mental health field; can advertise and provide services under the title of a case manager or geriatric care manager.
You can imagine the potential risk this may pose for a vulnerable senior or person with special needs, if the wrong person is brought into your home to provide services, that they aren’t qualified to do.
The purpose of this article is to help provide readers with a basic understanding of what case management is, and the importance of being an educated consumer before hiring a case manager or geriatric care manager. Some of the things to be sure to check before hiring a person includes whether they are a nationally board certified, their experience, education, references, fees, hours of operation, and the terms of their written contract to name a few.
THE AFFORDABLE CARE ACT - CASE MANAGEMENT & CAREGIVERS
It is important that safeguards be put in place to ensure that there is not a conflict of interest between a case manager evaluating and determining a client’s needed services, and a company that is providing direct services (e.g. caregiving) for that same client.
An example of a possible conflict of interest would be when the Acme Homecare Agency asks a case manager employed within their company to conduct an evaluation for a senior client; and following that evaluation that same case manager recommends that the Acme Homecare Agency be the one to provide all caregiving services for that client.
The role of a Board Certified Case Manager is to be neutral and objective in their evaluation, and to make a recommendation for the client, based on what is in that client’s best interest.
The best way to avoid a potential conflict of interest is to have a client’s assessment and care plan developed by a case manager that is neutral and independent from the company providing caregiving services. In other words, a case manager who is not employed by the homecare agency.
According to the Centers for Medicare & Medicaid Services, care management services must be “conflict-free,” which has the following characteristics:
• There is a separation of care management services from direct services (e.g. caregiving)
• There is a separation of eligibility determination from direct services provision
• Care managers do not establish the levels of funding for individuals
• Anyone who is conducting evaluations, assessments and the plan of care cannot be related by blood or by marriage to the individual or any of their paid caregivers.
SOME TYPICAL CHALLENGES PEOPLE FACE
To follow are some of the many challenges that people face in an effort to help another person.
• Son seeking help when dad is taken to the ER with a massive heart attack
• Daughter exploring homecare services for mom who is struggling to care for herself
• Family struggling to find services for a teenager with schizophrenia
• Senior who wants to remain at home, but needs help
• Daughter searching for an assisted living facility in CT, for a parent who currently lives in FL
• Husband who needs to select services for his 50 year old wife with traumatic brain injury
• Family who wants to set up an advanced care plan for their parents who are in their 90’s
• Son living in Europe who needs someone to oversee dad’s care in a nursing home
WHAT IS CASE MANAGEMENT?
Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.
Source: Case Management Society of America
WHAT IS A CASE MANAGER?
Case managers are healthcare professionals (e.g. RN, LPC, LCSW) who help provide an array of services to assist individuals of all ages and their families cope with complicated health or medical situations in the most effective way possible, thereby achieving a better quality of life.
They help people to identify their goals, needs, and resources. From that assessment, the case manager and the client - whether an individual or a family - together formulate a plan to meet those goals.
The case manager helps clients to find resources and facilitates connection with services. Sometimes she or he advocates on behalf of a client to obtain needed services. The case manager also maintains communication with the client to evaluate whether the plan is effective in meeting the client’s goals
Source: Case Management Society of America
WHAT IS A GERIATRIC CARE MANAGER?
A certified geriatric care manager 's duties are similar to that of a certified case manager. The difference is primarily that the geriatric care manager works with seniors and their families only, whereas certified case managers work with people of all ages, depending on their specific education and training.
In other words, a case manager is also a geriatric care manager.
Again, it’s important to note that in the State of CT, anyone regardless of whether they have any education, training or experience in the health or mental health field; can advertise and provide services under the title of a geriatric care manager or case manager.
CERTIFIED CASE MANAGEMENT PROFESSIONAL CREDENTIALS
Over the years I have encountered a wide range of people who advertise themselves as a case managers, geriatric care managers or patient advocates; yet many of these people don’t have the necessary knowledge, education, or experience to become a board certified professional in the field.
In order to become Board Certified, a person must show that they have the necessary education and experience to qualify to sit for and pass a national certification examination.
In order to keep their certification, a case management professional must then take continuing education courses each year, follow professional standards of practice, and renew their certification as determined by their certifying board.
Currently there are 4 types of case management professional certifications in the U.S.:
1. Certified Case Manager (CCM)
To be eligible to sit for this national exam a person must:
- Have a current, active, and unrestricted state Licensure or Certification in a health or human services discipline. The license or certification must allow for them to conduct an assessment independently.
- They may also qualify if they have a BS or graduate degree in social work, nursing, or another health or human services field that promotes the physical, psychosocial, and/or vocational well-being of the persons being served.
- A person must also have 12 months of acceptable full-time case management employment experience in the last five years, supervised by a board-certified case manager (CCM) or 24 months of acceptable full-time case management employment experience in the last five years without supervision by a CCM.
- There is also a requirement of 80 hours of continuing education for each certification period
2. Certified Social Work Case Manager (C-SWCM)
To be eligible to sit for this exam a person must have:
- A baccalaureate degree + a current state BSW-level license
- At least 3 years and 4,500 hours of paid, supervised, post BSW professional experience
3. Certified Advanced Social Work Case Manager (C-ASWCM)
To be eligible to sit for this exam a person must have:
- A master’s degree in social work + a current state MSW level license
- At least 2 years (equivalent of 3,000 hours) of paid, supervised, post-MSW case manage-ment experience
- There is also a requirement of 20 hours of continuing education for each certification period
4. Care Manager Certified (CMC)
To sit for this certification exam a person must have:
- A baccalaureate degree or master’s degree in a field related to care management
- 2 years of paid full time experience + 50 hours of supervision per year
By preparing for and passing the national certification exam, board certified case management professionals demonstrate they have the expertise, knowledge and professional experience to provide the right services to patients across the continuum of care. These individuals are committed to uphold the highest professional and ethical standards.
To maintain their case management credentials, a board certified professional must comply with the Code of Professional, must apply apply for recertification, and complete the required continuing education credits.
THE ROLE OF A BOARD CERTIFIED CASE MANAGEMENT PROFESSIONAL
Seniors, people of all ages with special needs, caregivers, or professionals who are feeling uncertain as to what to do, are increasingly using the services of a certified case manager to assess and implement plans that address a client’s day to day needs. certified case manager provide a consistent contact for family members, and they can do everything from creating an overall care plan to intervening in case of a crisis or emergency.
Board certified case managers are specialists who assist seniors, people with special needs and their families; in planning for and implementing ways to allow for the greatest degree of health, independence, safety and quality of life.
They meet with the client and /or family members to assess their needs, develop a Care Team, and work with members of the Team to formulate a comprehensive Care Plan (a road map).
Once a plan is in place, certified case managers are available to serve as the point person to monitor and coordinate services, and revise the plan as needed. Their role is similar to the conductor of an orchestra; ensuring that there is good communication, teamwork, and that everyone remains focused on the desired goals.
Case management is a collaborative process that consists of four steps:
- Development of a Care Plan (based on the unique needs of the client)
- Implementation & Monitoring of the Plan
- Ongoing Evaluation of the Plan’s Effectiveness, and Plan Modification as Needed
Depending on the board certified case manager’s specific training and experience they may provide a wide range of services focusing on health and mental health including crisis intervention, counseling, case management, housing management, money management, referrals, guidance, and support.
WHO NEEDS A BOARD CERTIFIED CASE MANAGEMENT PROFESSIONAL
Seniors, people of all ages with special needs, caregivers, or professionals who are feeling uncertain as to what to do, are increasingly using the services of a certified case manager to assess and implement plans that address a client’s day to day needs. Certified case managers provide a consistent contact for family members, and they can do everything from creating an overall care plan to intervening in case of a crisis or emergency.
Attorneys also sometimes rely on certified case managers to evaluate a client’s situation in their home, a nursing home or assisted living facility. Trust officers or other financial planners also use certified case managers to create workable, cost - effective plans of care, and doctors or other health care professionals often rely on certified case manager s as intermediaries between a patient and the health care system.
PAYING FOR A BOARD CERTIFIED CASE MANAGEMENT PROFESSIONAL
Board certified case managers bill their clients privately on a fee-for-service basis. The services provided by these professionals are not covered by Medicare or Medicaid, but some private insurance policies and long term care policies may cover the cost. If you are thinking about hiring a certified case manager, it’s important to check your policy to find out if it covers this type of service.
Even if you have to pay for a certified case manager’s services out-of-pocket, the work they provide in arranging for cost effective care - and easing the worries for seniors people of all ages with special needs, and their loved ones - can make the initial costs well worth it.
FINDING A BOARD CERTIFIED CASE MANAGEMENT PROFESSIONAL
When looking for a certified case manager, you’ll want to interview several in the community, so that you can find the one that best suits the client’s needs.
During these interviews, ask about background, services, qualifications and areas of expertise.
Also look for someone who you can get along with; after all, this person will be someone you’ll be working with closely over the next several weeks, months or even years. Make sure to check references and their professional reputation.
Linda Ziac, LPC, LADC, BCPC, CEAP, CCM, CDP is the owner and founder of Employee Assistance Professionals, Inc. a CT corporation located in Greenwich CT; which has been serving the community since 1990. The Caregiver Resource Center is a division of Employee Assistance Professionals, Inc.
Ms. Ziac has more than 40 years of experience in the health and mental health field as a licensed professional counselor, licensed alcohol and drug counselor, nationally board certified professional counselor, nationally certified case manager, nationally certified employee assistance professional, nationally board certified PTSD clinician, and a board certified dementia practitioner. In addition, Ms. Ziac has 15 years of experience coordinating care for her own parents.
Ms. Ziac assists seniors, people of all ages with special needs, and their families; in planning for and implementing ways to allow for the greatest degree of health, safety, independence, and quality of life.
Ms. Ziac meets with individuals and family members to assess their needs, and develop a Care Team, while working with members of the Team to formulate a comprehensive Care Plan (a road map).
Once a plan is in place, Ms. Ziac is available to serve as the point person to monitor and coordinate services, and revise the plan as needed. This role is similar to the conductor of an orchestra; ensuring that there is good communication, teamwork, and that everyone remains focused on the desired goal.
THE CAREGIVER RESOURCE CENTER
The Caregiver Resource Center ‘s approach with our clients is unique in that we’re available for our clients whenever and wherever they need us.
- Doctors’ Office
- Short Term Rehab
- Assisted Living
- Nursing Home
We are available 7 days a week by appointment and 24/7 for client emergencies.
We are specialists who assist seniors, people of all ages with special needs, and their families in planning for and implementing ways to allow for the greatest degree of independence, safety and quality of life.
Our spectrum of health and mental health case management and advocacy services provide flexible options to help plan for and address a client’s current and evolving needs – “the what-ifs”.
To learn more about our services visit us at http://www.caregiverresourcecenter.com/
Photo from Microsoft
The information in this article is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient provider relationship, and should not be used as a substitute for professional diagnosis and treatment.
Please consult your health care provider for an appointment, before making any healthcare decisions or for guidance about a specific medical condition.
Linda Ziac is the owner and founder of The Caregiver Resource Center. The Caregiver Resource Center is a division of Employee Assistance Professionals, Inc. which Linda founded in October 1990. The Caregiver Resource Center provides a spectrum of concierge case management and advocacy services for seniors, people with special needs and families.
Linda’s professional career spans more than 40 years in the health and mental health field as a CT Licensed Professional Counselor, CT Licensed Alcohol and Drug Counselor, Board Certified Employee Assistance Professional, Board Certified Case Manager, and Board Certified Dementia Practitioner. In addition, Ms. Ziac has 15 years of experience coordinating care for her own parents.
Linda assists seniors, people with special needs and their families; in planning for and implementing ways to allow for the greatest degree of health, safety, independence, and quality of life. Linda meets with individuals and family members to assess their needs, and develop a Care Team, while working with members of the Team to formulate a comprehensive Care Plan (a road map).
Once a plan is in place, Linda is available to serve as the point person to monitor and coordinate services, and revise the plan as needed. This role is similar to the conductor of an orchestra; ensuring that there is good communication, teamwork, and that everyone remains focused on the desired goal.