Experts Can Advise You
And Push for Your Best Care
When Nancy Skinners mother began, at age 84, to suffer from
dementia and some physical disabilities, Skinner realized she needed some help to find the
best care for her. And when her mother was scheduled to get out of the hospital while
Skinner was out of town on business, she decided what kind of help that would be: She
hired an independent case manager.
If you haven't heard of case
managers, you're not alone. They're probably the best-kept secret of health-care advocacy.
Case managers are generalists with expertise in both medicine and insurance who can look
at the big picture and negotiate on a patient's behalf to be sure they're getting the best
care at the right time.
The field grew in the 1980s as insurance companies
hired case managers often registered nurses to be sure a patient's care was
done efficiently and according to the insurance company's rules. In recent years hospitals
have hired case managers to keep costs down.
But now, happily for patients, individuals can hire an
independent case manager to work on their own behalf. For an hourly fee, a case manager
will review your medical and insurance situation and recommend a plan. Case managers are
being used most frequently by families of the elderly, who face a dizzying array of
options these days: Does a sick parent need to be in the hospital, a nursing home, an
assisted-living facility, adult day care or some other new concoction of the health-care
marketplace? For members of the "sandwich generation," these issues often arise
at the same time they're trying to raise children and run a two-income household. Handing
over some of the research and legwork to someone who knows the system and can
manipulate it can be a very attractive prospect.
That's how it worked out for Skinner, who hired a case
manager with expertise in geriatrics for her mother even though Skinner has the expertise
herself (she's a case manager and the president of the field's professional society).
"Sometimes you need someone who is not emotionally involved in the situation,"
Skinner says. "Caring for your parents' needs can become a full-time job. Many of us
can't do that."
Among the things the case manager took care of were:
|Working with a discharge planner at the
hospital to decide whether Skinner's mother should go back to her assisted-living facility
or to a nursing home.|
|Arranging for a home-care worker to come in and
help her mother a few hours a day when it was decided she could go home, but not without
|Making sure the doctors at the hospital and at
the assisted-living facility were on the same page.|
|Evaluating health-care facilities and comparing
their services and costs. |
the hospital and the assisted-living facility each had case managers to help coordinate
care, they were responsible for many patients in a large facility, and Skinner wanted to
be sure she had an advocate who knew all the details of her mother's situation.
"I needed someone whose sole allegiance was to my
mother," she says.
It all may sound good, but can you afford it? Skinner
thinks the final cost was worthwhile, considering the alternative, that her mother could
have ended up in the wrong facility, getting sicker or paying for care she didn't need.
Skinner paid $65 an hour to the case manager, who spent 10 to 15 hours on Skinner's case
over a month's time. Case managers' rates vary by region, ranging from about $50 to $120
Some independent case managers offer a package deal
for families with an ailing relative. For instance, Maura Davis is an RN and certified
case manager who runs an independent case management business out of Duxbury, Mass. She
charges $175 for a 90-minute functional assessment; and $350 for a three-hour session that
also includes specific recommendations of a nursing home or other facility, and a roster
of appropriate health-care specialists and financial planners to help with estate
planning. Beyond that, she charges $65 an hour to "run interference," which
often is only a few hours' work. A major crisis, Davis says, will usually take up about
eight hours of a case manager's time.
While Davis' business is being marketed to families of
the elderly, case management can also be helpful for people in other situations, she says,
such as someone with a life-threatening disease, recovering from a serious accident, or
with a chronic ailment.
When a patient is
having a major disagreement with an insurer, it can be more effective to hire a case
manager as an advocate than a lawyer, Davis argues.
"You're less likely to create a hostile environment," she says. "As soon as
most folks know you have a case manager on your behalf, you'd be surprised how they say,
'Yeah, yeah.' I'll call the insurance company and say, 'I know you can flex the benefits
for an extra day,' " says Davis, herself a former insurance company case manager.
Before hiring an independent case manager to go to bat
for you, check credentials. There are several types of certification for case managers,
one offered by the Case Management Society of America, which tests applicants in both
their clinical and financial knowledge. Ask questions like:
|Do you have a nationally recognized
|What is your health-care background (nursing,
|How long have you been in case management and
what is your experience?|
|How much do you charge per hour and do you
charge the same rate for travel time as you do for coordinating care?|
|How much time do you think this case will take?|
|Do you have references?|
the hardest part about hiring a case manager is finding one. Because it's such a new
trend, there aren't any easy referrals available, although the case management society
expects to have a referral system in place by the end of the year. Another organization,
the Geriatric Case Managers of America, has a directory of its members that can be
obtained by calling the Tucson, Ariz.-based group at (520) 881-8008. You can also try
asking the local hospital whether it has a list of independent case managers, sometimes
also called care managers. Check with the hospital's patient advocate or discharge
Davis is convinced case managers will help level the
playing field between patients and the "health-care industrial complex," as she
calls it. "When I see these stories about people who have trouble getting care, I ask
why didn't they get a case manager? It breaks my heart that people don't know it's
Local Case or Care Management is available as a
free service with our Long Term Care coverage and is highly recommended.
You are Not obligated to use this service or to accept any of their advise or
recommendations. However, you no doubt will find that this service and knowledge will be
of great value to you.
Also see FAQ's No. 6
Long Term Care