This paper will describe the criteria and strategies for termination of case management. The discussion will be on how independent care will help in continued client growth. The process focuses on discontinuing case management when the client transitions to the highest level of function, the best possible outcome has been attained, or the needs/desires of the client change. Criteria for termination of case management
The termination of case management may include but is not limited to the following: The injured worker achieves maximal medical improvement as determined by the authorized treating physician. The case is determined by the payer to no longer meet the criteria for case management. The case management assignment has been for the achievement of certain directives which have been addressed. The injured worker achieves successful return to work.
The court orders cessation of medical case management (Kane, 1993). Strategies for termination of case management
Termination of case management services is appropriate on many occasions and may occur for a variety of reasons. In addition to procedures to insure a client’s due process rights, the case manager will use an assortment of skills to help the client successfully separate from the relationship. Termination of the case manager/client relationship is the final step of the case management process. It is common for both the case manager and the client to respond emotionally to termination of the case management relationship. How each responds to the termination is influenced by experiences of the past, the intensity of the client/case management relationship, and the circumstances which precipitate termination. Case managers need to examine their personal responses to separation and loss so that they can be aware of how those feelings may impact decisions to terminate case management services (Annemarie, 2001).
When the case manager discusses termination of services, the client may experience a sense of abandonment, rejection, betrayal, or loss. When the client fears termination of services, the case manager may observe a decline in the client’s progress toward established objectives or may observe some avoidance behaviors on the part of the client. Other clients may have no observable response because they have insulated themselves from such emotions due to hurtful separations of the past. The case manager will need to assess each client to determine his or her reaction to the termination of services and make an effort to deal with the negative emotions or reactions of the client. The ideal condition for discharge occurs when the client has met his or her desired outcomes and the case manager and client mutually agree that there is no longer a need for case management services.
In this instance, discharge may be viewed as the client’s “graduation” to a more independent way of life (Rothman, 1998). At other times, circumstances that result in termination of case management services may be less than ideal. For example, the client may lose eligibility for the service before reaching desired outcomes or the case manager may be unable to continue the relationship due to client non-compliance, lack of progress towards established goals, or health and safety concerns. Other strategy may begin a relationship with a client knowing that some degree of intervention will be required on a long-term, open-ended basis. Intervention may be needed due to the physical, mental, or emotional condition of the client or may be related to the client’s circumstances such as poverty, abusive relationships, or capacity. An example would be case management services offered to a person who is diagnosed with AIDS. The client may function quite independently except at various crisis points during which the case manager may need to provide fairly intensive services.
The case manager needs to periodically review the purpose of continuing the case management relationship with the client. The decision to discharge a client from care needs to be carefully considered depending on the client’s level of dependence on the case manager. The case manager may need to gradually decrease the level of contact with the client functioning more and more independently. The gradual decrease in contact may not be necessary if the client’s stability is not be grounded in the relationship with case manager. The case manager must use their professional judgment to determine the appropriate movement toward termination. In some cases the client may also lose access to other helpful services and resources once the case management relationship is terminated. This is true with case management services provided through a home and community based waiver programs, for example.
When the loss of services is involuntary and will leave the client with on-going needs, the process of termination may require some additional consideration. Case conferences that include the client, caregivers, service providers, and legal counsel may be needed to insure that the client is not being abandoned. The case manager has a responsibility to help the client successfully locate alternative ways to meet their needs when current services are lost. In some situations, referrals to protective service organizations will be warranted if the client’s unmet needs will place the in need of protection (Standards of Practice for Case Management, 2010) The case management relationship with a client may end due to changes in the case manager’s situation. For instance, a case manager who resigns from his or her job assignments may need to address the client’s emotional response to the loss. The case manager will also need to help the client get reassigned and connected to another case manager to insure the continuity of care. Independent care will help in continued client growth
Clients learn to be more independent with managing life decisions and service plans and ultimately, the need for ongoing intervention by the case manager is minimized. Some clients will be able to participate in decision-making more than others. The participation of some may be limited by physical, mental, social, or emotional challenges. Client involvement should still be sought and honored to the extent possible. The chance that a person will make wise decisions is greatly enhanced when the case manager assists the client to identify all the options available to them. The person may identify some options independently and the case manager may present some additional options about which they were unaware.
Annemarie Pucher (2001), Case Management: a Consolidated View of Customer Care, 4th edition journal publication Kane, Rosalie A., and Caplan, Arthur L., (Ed) (1993). Ethical Conflicts in the Management of Home Care, page 44. New York: Springer Publishing Company Standards of Practice for Case Management, (2010). Retrieved from http://www.cmsa.org/portals/0/pdf/memberonly/StandardsOfPractice.pdf Rothman, J., & Sager, J. S. (1998). Case management: Integrating individual and community practice (2nd ed.). Boston, MA: Allyn and Bacon.