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Basic Budgeting for Consumer Directed Care

Professionalising Case Management
Presented by
Lorraine Poulos
 Acknowledgement of traditional owners
 Background to presentation
 Current environment – aged/disabilities/health/childcare moving to a
consumer driven human services where funding follows consumer
 Moving to a ‘user pay’ system
Implications for Case Managers in changing
 The importance of intermediaries
 Consumer preferences
 Positioning
 Infrastructure and costs
 Culture and readiness
Lorraine Poulos and Associates
Identified skills
The Community Services and Health Industry Skills Council environmental scan
 Case management
 Care planning
 Financial management
 Leadership skills
Australian Aged Care Quality Agency INA 2014 confirmed these with the addition
 CDC- budgets, choice, enablement
 Quality Customer service
 Consumer engagement
 Identifying and managing risk
Current state of play
 Case Management service type out of CHSP – why ?
 RAS- short term re-ablement case management in model – early days
 NDIS –planners
 CDC – consumers questioning value of ‘Case Management’
 Confusion over what it means- co-ordination, rostering, short
term/joint/ long term
Why misunderstanding or lack of ‘value’
 Case Management unable to be ‘defined’ by those actually doing it !
 Use of jargon when describing to clients particularly those who can self
 Poor documentation and evidence of timely interventions/support e.g.
mental health, aged care
 Very poor skills in marketing services and benefits, lack of
All resulting in a reduction in the ratio of
Case Managers to clients
Case Management – CMSA definitions
case management is a collaborative process of assessment,
planning, facilitation and advocacy for options and services to meet an
individual’s holistic needs through communication and available
resources to promote quality cost-effective outcomes.
CMSA, National Standards of Practice for Case Management, 3rd Edition 2013
Case Management – CMSA definitions
Case Management is a process, encompassing a culmination of consecutive
collaborative phases, that assist Clients to access available and relevant
resources necessary for the Client to attain their identified goals.
Key phases within the case management process include: Client identification
(screening), assessment, stratifying risk, planning, implementation (care
coordination), monitoring, transitioning and evaluation.
Within the case management process the Case Manager navigates each phase of
the case management process (as applicable) with careful consideration of the
client's individual, diverse and special needs, including aspirations, choices,
expectations, motivations, preferences and values, and available resources,
services and supports.’
CMSA, National Standards of Practice for Case Management, 3rd Edition 2013
Key phases within the case management process include:
client identification (screening)
stratifying risk
implementation (care coordination)
transitioning and
Case Management within Human Service delivery
Case Management, as it is understood by
professionals, promotes clients to self
manage as much as possible whilst
stratifying, evaluating risk and barriers to
clients achieving goals – (social and
health determinants)
Case Management Concepts
 FACILITATES the personal development of Clients
 ADVOCATES for Client rights.
 PROMOTES sustainable solutions.
is underpinned by COMMUNICATION
CMSA, National Standards of Practice for Case Management, 3rd Edition 2013
Professional training provided to Case Managers via
 Case Management Society of Australia CMSA – competency training in
National Standard and Code of Ethics
 National Skills Set for Effective Case Management
 Certification process – National Register and data base
Organisations identifying lack of evidence of skills in documentation via pre
and post QR and TPV audits
What are the skills set ?
 Advocacy
 Care planning including measurable goal setting
 Case conferencing
 Communication – written and verbal
 Cultural sensitivity
 Documentation
 Financial acumen
 Interviewing and assessment
 Networking and collaboration
Some documentation requirements
 Assessments relevant to client/consumer need
 Care plans
 Budget discussions (if relevant)
 Progress notes
 Appointments
 Reports
 Referral reports
 Phone calls
 Review of the case management practitioner or professional actions i.e.
advice, support, linking, promotion of independence etcetera
Why Should I Care?
 It is the law
 Case notes can be subpoenaed as evidence in court cases
 Clients (or the person they appoint) have a legal right to access their personal
records and read what you have documented
 Your organisation’s contract with the funding body legally requires you to
comply with specific Standards
 What you document will impact on the quality and accuracy of a client’s care
and the quality and accuracy of communication with other stakeholders
 Efficient and detailed case notes provide case management practitioners and
professionals with greater legal protection and accountability in practice.
Conversely, they serve to prompt the recall of memories (i.e. information and
events and actions) if required at a future date or court proceeding
Incorrect Documentation
 Statements which are judgmental and subjective
 Incomplete entries
 No signature or designation
 Inaccurate
 Not dated
 Important information missing
 Spaces allowing for corrections or changes
 Hard to follow
 Inappropriate opinions, labels, personal judgement or value laden
language that is open to personal interpretation
Goal and Care Plan
 What are the clients abilities?
 What will the service do?
 What will the case management practitioner or professional do?
 When/How will the case management practitioner or professional
review the achievement or progress?
Purpose of a Case Conference
 Inter-multi-disciplinary group process convened to review
a care plan
A professional forum to share and exchange information
Meet and collaborate with other key stakeholders involved with the client
and/or their significant other
Define, identify and/or clarify roles, tasks and functions of all key stakeholders
Receive updates from key stakeholders
Clarify information or concerns from the client and/or their significant other
and/or key stakeholders
Review existing goals, interventions and progress
Future planning and delegation of tasks
Other matters
 Case management/core advisory need to be ‘articulated’ on care plans in
a meaningful format
Financial conversations
Meaningful solutions
Assistive technologies
Culture change
Fixed cost and variable incomes- case management suffers
Lorraine Poulos and Associates
Other matters
 Case scenario planning – 50% occupancy
 Marketing – needs to ‘sell’ case management
 NDIS and CDC – empowered consumers LOVING it !
 Home Care today/ NDIS – information for consumers about case
management/core advisory
Examples of little or no evidence in files of co-ordination or case
No system of reviewing files for accuracy and contemporaneous notes
Training expensive
Financial skills of staff
Lorraine Poulos and Associates
If we are ‘Case Managing’ we need:
 Evidence of all skills via training
 Confidence in our abilities
 Specialist skill development e.g. dementia, youth issues, restorative care,
clinical care
 Understand the clients right to choose – dignity of risk/duty of care
balances (see Home Care Today website resource)
Informed and empowered clients may choose to
NOT have our case management services!
attitudes are the real disability
Thank You
Further details contact
Lorraine Poulos and Associates
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