Basic Budgeting for Consumer Directed Care

Presented byLorraine PoulosProfessionalising Case Management

1 Acknowledgement of traditional ownersBackground to presentationCurrent environment aged/disabilities/health/childcare moving to a consumer driven human services where funding follows consumerMoving to a user pay system

22 2013 Lorraine Poulos & AssociatesImplications for Case Managers in changing environments The importance of intermediariesConsumer preferencesPositioningInfrastructure and costsCulture and readiness

Lorraine Poulos and Associates 33Identified skills 4The Community Services and Health Industry Skills Council environmental scan 2013/14:Case managementCare planningFinancial managementLeadership skillsAustralian Aged Care Quality Agency INA 2014 confirmed these with the addition ofCDC- budgets, choice, enablement Quality Customer service Consumer engagement Identifying and managing risk

Current state of play5Case 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 termWhy misunderstanding or lack of value6Case Management unable to be defined by those actually doing it !

Use of jargon when describing to clients particularly those who can self manage

Poor documentation and evidence of timely interventions/support e.g. mental health, aged care

Very poor skills in marketing services and benefits, lack of research/evidence 7All 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 individuals holistic needs through communication and available resources to promote quality cost-effective outcomes.

CMSA, National Standards of Practice for Case Management, 3rd Edition 20138

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

9

Key phases within the case management process include:

client identification (screening) assessment stratifying risk planning implementation (care coordination) monitoring transitioning and evaluation10

Case Management within Human Service delivery11

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 ConceptsFACILITATES the personal development of ClientsADVOCATES for Client rights.is PURPOSEFULPROMOTES sustainable solutions.is underpinned by COMMUNICATION

CMSA, National Standards of Practice for Case Management, 3rd Edition 201312Professional training provided to Case Managers via CMSA13Case Management Society of Australia CMSA competency training in National Standard and Code of EthicsNational 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 auditsWhat are the skills set ?14Advocacy Care planning including measurable goal settingCase conferencingCommunication written and verbalCultural sensitivityDocumentationFinancial acumenInterviewing and assessmentNetworking and collaboration Some documentation requirementsAssessments relevant to client/consumer needCare plansBudget discussions (if relevant)Progress notesAppointmentsReportsReferral reportsPhone calls Review of the case management practitioner or professional actions i.e. advice, support, linking, promotion of independence etcetera15

16Why Should I Care?

It is the lawCase 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 documentedYour organisations contract with the funding body legally requires you to comply with specific StandardsWhat you document will impact on the quality and accuracy of a clients care and the quality and accuracy of communication with other stakeholdersEfficient 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 proceeding1616The Scare Slide!Incorrect Documentation17Statements which are judgmental and subjectiveIncomplete entriesNo signature or designationInaccurateNot datedImportant information missingSpaces allowing for corrections or changesHard to followInappropriate opinions, labels, personal judgement or value laden language that is open to personal interpretation

18What 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?

Goal and Care PlanPurpose of a Case Conference19Inter-multi-disciplinary group process convened to review a care plan A professional forum to share and exchange informationMeet and collaborate with other key stakeholders involved with the client and/or their significant otherDefine, identify and/or clarify roles, tasks and functions of all key stakeholdersReceive updates from key stakeholdersClarify information or concerns from the client and/or their significant other and/or key stakeholdersReview existing goals, interventions and progressFuture planning and delegation of tasks

Other mattersLorraine Poulos and Associates20Case management/core advisory need to be articulated on care plans in a meaningful formatFinancial conversationsMeaningful solutions Assistive technologiesCulture changeFixed cost and variable incomes- case management suffers

20Other mattersLorraine Poulos and Associates21Case scenario planning 50% occupancyMarketing needs to sell case managementNDIS 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 managementNo system of reviewing files for accuracy and contemporaneous notesTraining expensiveFinancial skills of staff

2122 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!23

attitudes are the real disability

24Thank YouFurther details contactlorraine@lorrainepoulos.com.au

Lorraine Poulos and Associates

24