Charles E. Roberts, MSW/CSW
All too often a family member is thrust into a situation of being the point person or decision maker when another family member is stricken with an incapacitating illness, catastrophic injury, or has died.
Mom may have had a stroke, nervous breakdown, or outlived her spouse and now is getting old and infirm, both of body and mind.
A child may have sustained a devastating head injury or spinal cord injury in a car accident, or worse yet, been shot or beaten up in a fight, or has become drug addicted.
Dad may have had a heart attack, been injured at work, or fallen off a ladder working around the house.
Also, someone in the family may have died and there is a need for someone to handle bill payments, negotiate settlements on bills, file Social Security forms, insurance forms, dispose of property and, in general, wrap up the many miscellaneous details.
This is not a job that anyone really wants, but necessity dictates that someone make the decisions and someone do the work.
As it has been said many times, “It’s a jungle out there”.
Guess What: YOU’RE IT!!!
You will have the responsibility of sorting through and negotiating medical, hospital, service provider, vendor, insurance, and the legal maze. You will also be faced with making all the purchasing decisions for medications, equipment, supplies, and nursing or home care attendant staff.
Who is going to decide who will be the treating doctor, the specialist, and provide ongoing therapy?
Often, the family physician has no knowledge for the specialties required and to whom to refer.
Moreover, the physician may have too many patients and doesn’t have the time to keep up or be current on which specialist is good or what the state of the art treatment is in the specialties required.
The hospital may be self-serving, limited, and/or invested in their own programs, which may not be the best for your family member.
You will be challenged to make the budget, financial, and purchasing decisions.
You may have to argue or deal with the insurance company, hospital, the Department of Social Services (DSS/Medicaid) or Social Security.
Have you chosen the right attorney? Can the family or referral attorney handle the intricacies of the case?
If nursing home placement is an issue, which is the right one for your Mom. And will the rest of the family agree? Is Mom in this state or is the family out of state?
Is the hospital and/or doctor bill right? Can it be negotiated, discounted, or can the fees be waived? Is the hospital fee an overcharge and/or will the hospital accept from you what they accept from Medicare or Medicaid?
Is the insurance company being up front, factual, and are they paying for the right services? Are claims representative and/or insurance company retained case managers explaining correctly what is covered under the policy or are they expecting you to provide the bulk of the care for free?
You have never been through any situation like this in your life.
YOU are now the boss. You have now been put in the position to make these decisions.
YOU are now the case manager.
Yes, YOU do have some choices.
This is the point where a professional case manager becomes invaluable.
If you have the money and can afford a professional case manager, then he/she can take these problems out of your hands, present you options, negotiate, and do the running around.
The case manager can gather the information and YOU can be the Chairman of the Board. You will make the final decisions after all the information has been presented to you.
A case manager may be provided by an insurance company, particularly in a liability situation, or you may choose your own case manager to assist and those fees may also be paid by the insurance company.
Often case management fees can be paid through the savings that the case manager negotiates while handling the case.
A case manager can be worth it by reducing stress, knowing the ins and outs, and they can provide a wealth of information and options you never would have thought of, as well as, be a good counselor and a good listener.
Using a case manager to hire and supervise home aide or attendant care staff may allow you to continue to hold down your job when otherwise you or your spouse might have to quit your job in order to take care of an elderly or infirm parent, or an injured child.
You may be able to use a case manager as a counselor and/or planner, and you could do some of the legwork, thus save money, if the fees are not covered through your insurance.
But, more often than not, YOU WON”T HAVE THE MONEY to hire a professional case manager and you will have to do the decision making, running around, gathering information, interviewing, and all the other odds and ends – while still trying to hold down your job, care for your family, and live a life.
This guide is provided in hopes that it can help you along the path and make handling the details of care, and care planning, a little easier.
Or, you may be able to use this guide in selecting a case manager or to check up on your current case manager.
Good Luck!