Case Management Needs Assessment| Comprehensive Case Management Certification

Hey there everybody, and welcome to this presentation on case management needs assessment. I'm your host, Dr. Donnelly Snipes. In this presentation, we're going to explore the different domains which can be assessed and addressed by the case manager. Let's start out by talking about why case management. Why do we even care about this? Well, the mind and the body interact. So when people are experiencing a lot of stress, for example, they may start having physical, physical health issues, issues with their energy, sleep problems. They may just feel plum overwhelmed. Likewise, if they're struggling with a health issue, if they're recovering from surgery or something, they may not be as cognitively clear because their body's trying to recover or they're on a lot of medications. So sometimes people need case management or could benefit from case management services even if it's not considered, quote, medically necessary by the insurance companies. When people experience distress, it impacts all areas of their life. Think about when somebody's grieving. A lot of times when people are grieving, it changes their appetite, it changes their sleep, they feel overwhelmed, they may get agitated, it hurts their productivity at work. You know, there's a lot of areas that kind of need attention when somebody is a grieving and they may not have the energy or wherewithal to attend to those at that point in time. Likewise, during some life changes like a divorce or a child moving out or a job loss or who knows what else, people may feel completely overwhelmed and there's a lot of stuff that needs to be done, but they don't know where to begin. And they may not even know all the things that need to be done. I was amazed at all of the things that needed to be done. When my mother died, that my, my stepfather spent the next, literally the next week on the phone with all these different places she passed away. I would have had no idea. So people can feel overwhelmed or they may just be ignorant about what needs to be done so they can use some assistance there. Sometimes people don't even realize all of the things that could be contributing to their distress. So a case manager, when they do a needs assessment can help people identify potentially little areas of their life that may be causing distress or irritation. All of those little things can add up and we're going to, to go through a lot of those in the rest of the presentation. It's important when somebody presents for case management that you start with their current concerns. What brought you here or what made you call the hotline today? And you know, how can we address those if they're not wanting Any other assistance past that, they just have a presenting issue and they want some referrals. Cool. If they are willing to partake in a full, you know, needs assessment, well, then that's great too. But you want to make sure that you are empowering the client and not trying to force them to do something that they're not ready or wanting to do. The goal is to empower the individual as much as possible using what's called scaffolding techniques. Letting the person do as much as they can to the point that they can, and then providing assistance to get them the rest of the way. When people are completely overwhelmed, they may just not even know where to begin. They have so much stuff to do to handle whatever's going on. And a case manager might say, okay, you know, can you make a list of all the things that need to be done? And if they say no, well, that's where you start. Or maybe they've made the list or they're able to make the list, but they look at that list and they get overwhelmed and they're like, I know, I can't even begin to start this. This is just too overwhelming. Then the case manager might be able to sit with the person and advocate for them or with them, encourage them, provide support to help them get started. Let's, let's start with the first thing on the list. What do we need to do? A lot of times case managers, especially in non clinical environments, case managers provide a lot of advocacy, support and encouragement to help people do the things they need to do. You don't want to do anything for the person that they can do on their own and that they want to do on their own. So the process starts out by doing what I call an assessment of needs. It's a screening. You're not diagnosing, you're not treating anything. You're just evaluating the multiple domains. Physical, affective, cognitive, environmental, and relational. You're going to evaluate all these different domains to see what kinds of needs the person may have and provide them them education, information about resources that are available to them and how to connect with those they may need assistance. If you've ever tried to navigate the health care system, for example, and insurance and everything else, it can feel extremely overwhelming. And with Medicare, for example, it feels even more overwhelming because there's all kinds of extra rules. So sometimes a person may need assistance kind of navigating and keeping everything clear in their mind. And a case manager can facilitate this process. A case manager can help the person navigate their way. You're not doing it for them, you're doing it with them. Case managers can provide education, psychoeducation, health education, general educational information about things like sleep, hygiene, proper nutrition, not making prescriptions, not telling the person what to eat, but helping them understand, for example, what a healthy diet looks like. Case managers can help people prioritize. Once they have this list of needs or list of things they, they need to do. Case managers can help people prioritize, okay, what are we, what needs to be done first, and what are the steps that need to happen in order to cross this off the list. A lot of times when people are feeling overwhelmed, they, they jump. They don't see baby steps for, okay, I need to do step one, two, three, and four. They just see I need to get to this end point. And I don't know how to get there because they're not, they're in a fight or flight mode when they're overly stressed. So they're not thinking as clearly and potentially as linearly as they would on an average day. So a case manager can assist with prioritization. Case managers can assist with identifying referrals and making appointments. Maybe the person needs to go down and get a new driver's license and they need an appointment for that. The person may feel just so overwhelmed with everything else going on, or they hate calling and staying on, on hold for 20 minutes or something. And that frustration or anticipation of frustration is keeping them from calling because they're like, I just can't take, I can't take one more thing. I can't deal with, you know, some being on hold for 20 minutes. Well, okay, so the case manager has gotten to, gotten them to the point where they need advocacy or assistance. So the case manager may help them through that process. And case managers can advocate and help them get linkages with resources to help them get their needs met. So the case manager may identify, for example, that the person doesn't have access to enough food. They may help the person link with food pantries or social service programs that can assist the person in getting their nutritional needs met. So some resources that are available, these are not all of them by any means. United Way 211 is the place you want to start. And it's 211 United Way.org and that is the national website. You go there, you can start looking for resources. Now, not everything is listed in United Way 211. It's important to remember that your local area may have other programs that aren't listed with United Way. So don't assume that you know everything by just calling that. If you're looking for specific services like food pantries or diapers or something, you may also consider calling around to local churches because all of their services are very often not listed. With United Way, the local area agency on aging will often have a list of services available to older adults, including senior centers and adult daycare. Now, adult daycare is different from senior centers because senior centers deal primarily with seniors who are healthy and, you know, functioning just fine. Thank you. Adult daycare is more medically oriented and it is more appropriate for older adults who are experiencing physical, cognitive or mental health issues that can benefit from being in a supported, structured environment. Disability specific services, and I use the term disability kind of loosely, the March of Dimes is a great resource, for example, for families that end up having a baby who is preterm. There's a lot of stuff to learn when you've got a preemie. Trust me, I had two of them. Autism Speaks is another website. Now, not everybody likes the Autism Speaks organization, but some people love it. And so it's important to be aware that it's a resource, but not necessarily the definitive resource. Diabetes.org, the American Heart association, the American Cancer association, hospice, you know, you can reach out to a variety of these different organizations to find out what condition specific services might be available in your area. For example, there are oftentimes summer camps for children with diabetes. So you may reach out to diabetes.org to find out about those resources. Universities and technical schools are also great places to reach out to. A lot of times they will have free clinics. When I was at the University of Florida, we had a law school there, and the law school had a free clinic that was available to people who were impoverished that could assist them with a variety of civilization and I believe even minor criminal offenses. They also help them with divorce proceedings and in child custody and those sorts of things. Our dental school offered free dental clinics for people to come in. The dental students would work on the patients, of course, but they got dental services for free hair styling. This obviously is generally more of a technical school thing, going to a beauty college, but a lot of times you can find very free or low cost hair styling services for men and women. People feel better when they look better, so if they feel like they need to have, you know, something done with their hair, you know, that can really help people, you know, perk up a little bit, especially if it's been a while. Audiology departments, counseling departments, and medical schools also may have free clinics available. Available so it's important to check with your local universities. They are a wonderful resource. If they offer a lot of these clinics. You can also check with the state Department of Adult Mental Health, Child Mental Health, Developmental Disabilities or Elder Services. Most states have departments for each one of these things. To find out about resources that are available, you can also look online for transitional housing, halfway housing and sober living. Now, transitional housing often refers to housing for people who are homeless or who are at risk of becoming homeless. Halfway houses and sober living may refer to people who are coming out of substance abuse treatment. Halfway houses may also refer to people who are coming out of jail or prison. It's important to know exactly what population the housing is serving in order to make the most appropriate referrals. All of these things are super helpful. The nar, the national association of Recovery Residences N A R R keeps a list of sober living facilities by state. In most cases, all of the sober livings in each state are not listed on the NAR website. They're just ones that are certified by nar, if I understand that process correctly. Still, it's evolving. It's a very new organization. So don't assume that you know everything. You can also go for sober living. You can look on the 12 step program website and and consider different options that are available to people who are needing sober living or halfway housing. Useful volunteer based services. Now, case managers are often doing the coordination of services. But if you are a case manager in a community, you may identify services that are needed that churches could potentially get together or community groups could potentially get together and provide as a service to the community. Case management hotline, what I call an outreach hotline. And this is a hotline where it's not a crisis hotline, but it's for people who are homebound especially who may start feeling very isolated so they can just reach out and call and talk to somebody. This can be really, really important. A lot of us never really real extent of isolation that a person might feel if they were confined to their home until 2020 came and went. And I think a lot of us have a lot more empathy for people who are homebound now. And you can recognize the need for that human connection, even if it is only on the phone. Yard work and minor home repairs are things. A lot of times churches will get together and somebody who's a general doctor in the church may supervise it to make sure that you know, everything's done well. Or they may have extra supplies that they donate. But those things can be completed by volunteers for people. Again, who for, for one reason or another, do not have the ability to do those things right now. Professional clinics, CPAs, counselors, dentists, doctors, dietitians, lawyers who are in the community may be willing to donate one day per month or one day per quarter even to have to volunteer their services to provide their professional services to people in the community who are in need. Support groups. A lot of times churches take the lead on this, but any organization really can offer support groups for depression, anger, anxiety, survivors of suicide, addiction, support groups, support groups for people with fibromyalgia or diabetes. You know, the list goes on. If there is an issue that causes distress, then potentially a support group could be helpful. Right now there is a huge need for people conducting support groups for people who are struggling with health anxiety. Recreational activities can be offered again by community centers, by libraries, by faith based organizations that give people a place where they can go, they can congregate, and they can connect with other people who share similar interests. Crochet clubs, art clubs, yoga, you know, people who want to get together and do yoga, book clubs. There are a lot of different things. Whatever your interests are, you can probably create some sort of group. You can advertise it on meetup.com or United Way 211-whatever, wherever you want to advertise it. But these activities give people a place to go where they may not, you know, not everybody wants to go to a bar or go to a gym or something, so they may feel more comfortable in a smaller group that's in their local community. Temporary housing at rotating churches is something that an organization called interfaith hospitality network provides in many communities throughout the nation. And each community has their own interfaith instance. So it's not, my understanding is it's not one, you know, huge national thing, but you can look online and you can find dozens of instances of interfaith hospitality networks. Basically, the churches get together and they agree to house people who are homeless for a week at a time. So First Baptist will have the first week in March, and the Catholic church may have the second week and, you know, on and on. So it provides additional resources for the community, for people who are homeless in the community to make sure that people who are unsheltered, people who normally would be sleeping literally on the street, have a safe, sheltered place to sleep. And while they're at the interfaith hospitality place, they can also access case management services and things like that that they meet may need to help them get back on their feet. Respite care, either in the home with the caregivers present, but not as much engaged. Giving the caregivers time to, you know, take a bath or whatever can be very helpful or facility based. So you may have respite care for new parents where the caregiver may bring their, the infant with them to the community center and there are activities that are going on and the children, there are volunteers that may be playing with the children, occupying the children. Caregivers stay on the premises for liability reasons, but they don't have to be actively engaged every second. They can take a break, they can drink some coffee or whatever they need to do. This can also be helpful for caregivers of adults, people, adults with dementia or other conditions. Sometimes caregivers, regardless of the age of the patient, need a, need a break, need some respite care. Weekend teen and tween activities, including volunteer activities like cleaning up the local park, can be great things that volunteers can do that give teens and tweens something to do. Because there's usually a lot of resources and a lot of activities for youth that are in elementary school and younger. But once they get into middle and high school, unless they're involved in school based activities like football or cheerleading, there may not be a lot for them to do which can, can lead to them being bored, getting in trouble, those sorts of things. So providing opportunities, even just opening up the community center and having board games available on Friday evenings, or having a DJ and music in the basketball area of the community center, whatever it is, those things can be extremely helpful for the whole community as well as for the parents and the youth. Food and pet food pantries are always in demand. You know, there's just always a need for food. It's important if you're running one of these pantries to also reach out to backyard gardeners so they know that when they have an excess harvest, when they can donate it at some of those pantries, maybe once a month at different places, there is a place where people can go to get fresh produce. Pet food that's returned to pet stores open, you know, the dog didn't like it or whatever, can't be resold. And a lot of times pet stores will donate that to either shelters, you know, animal shelters, or to churches or, or pet food pantries. Also, you know, if you have grandma and she had a dog and the dog passed away, Grandma may not want to get another dog, but she has all this food left over. She doesn't know what to do with it. That can be donated and obviously you'll have your own liability Regulations, you'll want to go over any of those services with a lawyer to minimize liability for your church or community center. And finally, clothing and blanket closets. A lot of times people, especially if they've got children at home, children grow so fast that they may have difficulty keeping their kids in clothing. I remember there was a period, I swear every three months my son was in a different size of shoes. So clothing and blanket closets can be very useful for people in the community. So let's talk about screening. I've talked about services that case managers can identify as being needed in the community. Those services that we just went over can be offered through community centers, through professional groups like the lawyers association, or through community groups like the the community center, the government, the Rotary Club. You know, the list is pretty endless. It's just a matter of asking and getting an organization that's willing to spearhead it. So when you're doing the assessment, what do you assess for? It's really not as difficult as it sounds. You want to ask people if they've had a physical within the past year. A lot of mood and pain issues can be caused by underlying physiological issues that may be very easily treatable. So a physical within the last year is really important for maintaining health and well being. An eye exam and a hearing check within the past year is really important. They poor vision, poor hearing contribute to cognitive decline, but poor vision can also contribute to migraines. It can contribute to car accidents. There's a lot of things that blurry vision can cause problems with. And hearing checks can contribute to difficulty in school, at work, in relationships. It can increase agitation because people are constantly straining to hear or they think they know what they heard and they're mishearing things. So it causes communication breakdowns. Hearing checks are really important, especially as people get older or if they listen to a lot of loud music like I do, those things can be important. Nutrition, assessing, you know, the person's diet, you know, are they familiar with healthy nutrition practices? Do they have access to enough healthy food and do they consume that healthy food? People may know how to eat health healthfully, they may be able to afford it with no problem. But they're living on ramen noodles and pizza because they're too depressed to actually cook or they don't know how to cook. So it's important to assess those things. After my mother died, my stepfather kept forgetting to eat. He just wasn't hungry. And he admitted that he doesn't know how to cook. There are a lot of ways to get food to people, whether you're bringing it, you know, the church is bringing casseroles or hospice or even just having, you know, grubhub or something. Bring meals to people, they can order them out. If they don't know how to cook, there's still no excuse anymore for not eating relatively healthfully. Medication. What do they know about the medications that they're on? Do they understand how they're supposed to be taking them? Are they able to afford their medications and get them? You know, know if you can afford it, great. But if it continues to sit at the pharmacy because you can't drive to the pharmacy to get it, that's a problem. So can, can they afford it? Can they pick it up? Can they get it? If they cannot afford their medication, Good Rx and other services like that can significantly reduce the cost. You can also go to the pharmaceutical company's website and look for the page or the section that is entitled Patient Assistance Program. Generally there's a one page form that the doctor fills out, faxes it in, and if the person is truly financially unable to afford their medications, a lot of times the insurance company will provide it at a very steep discount. So can they, do they know how to take it? Do they know what it's for? Do they know how to access it? Can they afford it? And are they taking it as prescribed? You know, are they remembering to take it? I know antibiotics that I have to take three times a day if I ever have those. Thankfully they pretty much don't exist anymore. I would always forget to take the middle of the afternoon dose, which is why I love the once a day antibiotics now, because it just helps. But especially people who take multiple medications, are they remembering to take them when they're supposed to take them? Them? There are apps you can download that remind you when to take which medications and they will bug the crap out of you, honestly, until you take your medication. So that can be really helpful for people who are forgetting to take their meds and complications. Talking with people, especially if they're not taking their medication, but even if they are taking it as prescribed, are they having any side effects since starting that medication that they're concerned about and if they are, make a referral back to the physician. You're not going to diagnose, you're not going to treat any of these things, but you can, you know, highlight and say, oh, that sounds like something you might want to talk to your doctor about. Sleep and circadian rhythms. What do they know about sleep hygiene? Do, are they aware of ways to get good quality sleep? Do they think they're getting good quality sleep? Are they waking up fatigued all the time? What do they know about circadian rhythms? When you're sleep and circadian rhythms get out of whack, it impacts everything from your mood to your immunity to your pain level, to your hunger and satiation and even managing your blood sugar levels. So making sure that people are, you know, assessing what they know about it. If people don't have knowledge about nutrition or sleep and circadian rhythms or a particular medication, a lot of times you can find handouts online that you can print out and give to them or you can email to them so they get the knowledge that they need in a succinct fashion. You know, obviously they don't want to read 17 journal articles, but providing them the basic information, your organization could also potentially create short little videos and put them online on your agency's website. I have a lot of videos on the YouTube channel here. I'll ceus education on sleep hygiene, on basic nutrition for mental health, the connection between pain and mood disorders. You know, there's a lot of stuff there. So for people who are interested in learning more about that, they can peruse either your organization's website or ideally you will have curated some playlists for them. So they're not going to just any Tom, Dick and Harry that has a video up on YouTube. You want to make sure that they're being referred to accurate information. So what do they know about it? Do they have the ability to get good sleep? Do they have sleep apnea? Do they have a baby that's waking up every two hours and they haven't gotten a good night's sleep in, you know, six months? Are they going through menopause and they're having night sweats and they haven't gotten a good night's sleep in six months? Are they, you know, working shift work so they can't ever seem to to figure out when they're supposed to be awake or asleep? All of these things can have a significant impact on their overall health. And it's a matter of brainstorming with them. What is it that you need in order to help you get adequate quality sleep and maintain your circadian rhythms? And a lot of that is very non clinical, unless they have something like sleep apnea or restless legs syndrome, in which case they may need to be referred to their doctor who can refer them for a sleep study. Pain. You know, pain's caused by a lot of different things, but if people are in pain, they're not going to sleep well, they're tending, probably going to tend to have a more irritable or depressed mood. So asking people about pain, do they, if they have pain, do they know what's causing it and do they know how to address it? If they do, great. If they're using those interventions, how effective are they? If they're using a tens unit or yoga or ice packs or whatever it is, are those interventions working or not? If they're using the interventions the doctor gave them or told them about and they're still not working, then advocating for them to reconnect with their physician or their physical therapist can help them manage that pain. Generally, pain is manageable. It may not be possible to eliminate it for everybody, but the goal is to get it to a manageable level. Other symptoms that it's good to ask people about, if they're willing to answer them, have they experienced excessive hunger, thirst or unintentional weight loss in the past couple of months? If they're under a lot of stress, like after a death, they may have unintentional weight loss. So, you know, use your best judgment. But excessive hunger or thirst may indicate pre diabetes. Numb numbness or tingling in their hands or feet may also be a early sign of diabetes. Slow healing sores, shortness of breath, unusual fatigue or weakness, or a persistent cough could also indicate some underlying issues like cardiovascular problems that probably should be checked out. So if you do a screening and people are experiencing some of these symptoms, encouraging them to connect with their physician is going to be important. Affectively. Now this, this one's actually relatively easy. Are they experiencing depression, anxiety, grief, guilt, anger, hostility? Okay, if so, what tools do they need or what could be helpful for them in dealing with those dysphoric emotions? You may make referrals to support groups, to pastoral counseling, to, you know, non pastoral counseling. If they are severely clinically depressed, you may be, you know, making an emergency referral to counseling and, or the emergency room. You want to help people figure out, you know, what resources, resources are out there to help me deal with these feelings that I've got going on right now. Case managers are not counselors necessarily. Most of the time they're not. So what you're doing is connecting people with the professionals who can help them work through this stuff. You also want to talk with them about happiness, relaxation and recreation. What is it that helps you feel happy and do you have access to that? If they do great, how can they do more of that if they don't, you know, what's preventing it. And is there a way to help you access some of these things that make you happy? For example, maybe seeing your grandbaby makes you infinitely more happier. Well, that can be wonderful. But in the current state of things, you may not be want to be traveling across the country to go see your grandbaby. So you may start feeling frustrated and depressed that you're not seeing the baby. Well, okay, so it's not the same as being able to hug and touch and hold. But video calls with the baby, video calls where you're present in the room and you know, just kind of hanging out with the family for an hour can provide a whole lot more connection, can let you feel that connection with that baby or that toddler that you may be be greatly missing. So exploring with people how they can connect with those things that make them happy and any of the things that they enjoy doing for relaxation and recreation, our bodies need to decompress, our bodies need to down regulate. Sometimes helping people identify hobbies they might enjoy doing, things that they might enjoy want to do, they can help make their life feel more rich, meaningful, fulfilled, abundant, whatever word they want to use Cognitively, how's their memory short and long term? Now, when people are in crisis, their memory usually is not great. When you're in a fight orf flight mode, when you're in con, when you're under extreme stress, your memory is not focus. Your mind is not focused on remembering things. It's focused on fight or flee. It's focused on protection. So it's expected that after a crisis or during a major life transition, people's memories are not going to be as good as they are, you know, quote normally. But if there are sudden changes in short or long term memory, or someone's short term memory is becoming progressively worse and referring them for an evaluation, even if they're younger, referring them for an evaluation is really important because early intervention can stave off cognitive decline even in people with dementia or Alzheimer's disease. Cognition. Are they able to think clearly? Are they able to formulate ideas and sentences and stay on on task to the best of their ability in conversations? My son has adhd, so staying on task is a little challenge, challenging for him, but he thinks very clearly. It's important to remember again that as we age and it's not dementia, you know, just there is normal slowing in our cognition. It takes us a little longer to do things as we get older. But if it seems like there's a marked change or it's getting progressively worse in a Concerning learning fashion, it's always better to have it evaluated. If the person's experiencing hallucinations, seeing or hearing things that aren't there, that is a big concern and they should be referred for an evaluation. If they're having delusions, that's another concern. And a lot of times people with dementia may start having delusions. A lot of people that I've worked with who've had dementia have paranoid delusions. They think people are out to get them. They pe think people that think people are stealing from them. Now, sometimes this is the case because people do unfortunately take advantage of vulnerable individuals. So you don't want to dismiss it and automatically assume it's a delusion. However, it's important, so you want to take it seriously. But it's also important to recognize if there is a pattern of unproven. You know, there is no evidence that someone was stealing from them or in the apartment, moving things around or something. That the person gets an evaluation by a psychiatrist to rule out any issues that may be causing those hallucinations or delusions, including psychotic features and depression, bipolar disorder, schizophrenia, or Alzheimer's or Parkinson's disease. Can the person list prioritize and follow through After a divorce, when a new baby comes home, and especially when a new baby comes home before you're sleeping through the night, when there's been some major upheaval in your life, are you able to list what needs to be done, prioritize it, and actually get done the things that have to be done? If not, that's a great place for a case manager to step in and advocate and facilitate using that scaffolding. You know, what is it that you can do on your own? You know, let's take baby steps. And sometimes the case manager just needs to prod people and say, okay, then the next thing on your list is to do this. So why don't you see about doing that and then call me back? You know, just helping people take those baby steps to nudge them through the day. Every small step forward is still a step forward. People who are having issues with cognition remind them to use notes and make lists if they're under stress after surgery, if they're on medication for some reason. There is nothing wrong with keeping notes and lists to jar your memory. Handouts can be really helpful to remind them about things like when to take their medication. SMS messages can be sent. They can even schedule their own SMS messages to be sent to them to remind them to do things. Apps are available, like I said, to remind you to take your medication or do activities of daily living posting schedules on the wall. I had one client that had schizophrenia and was in supported housing, but he needed a little bit more assistance remembering to do things like change his clothes, take a bath, clean the house. So we broke it down and each day he had a different chart that the caregiver would put up that would remind him what he was supposed to do. So like on Mondays he was supposed to swiffer the house and on Tuesdays he was supposed to clean out the toilet and there were just different tasks for each day. He was still able to live relatively independently, but he needed those prompts to remind him to get things done. Simplify and minimize get rid of as many distractions as possible. If the person feels overwhelmed and there's the environment is really busy, it may contribute to that feeling. Link and drop in care can also be helpful when people are starting to become to have more issues with independent living for whatever reason. Drop in care can be helpful where a CNA or a caseworker comes by once a day, once a week to check in on the person to help them with any thing that must be done. All of those things can be helpful. I talked about respite care earlier and that can be sometimes done in a drop in fashion, environmental and financial needs. Does the person feel safe? If they don't feel safe, that's going to be a primary target for figuring out what do they need in order to feel safe in their environment. If they don't feel safe, their HPA axis, their fight ORF flight response is going to be constantly ramped up and it's just going to cause a cascade of problems. So safety is important. Mobility. Can they get in and out of chairs and in and out of bed on their own? Can they get around the house on their own? Like can they get from the living room to the kitchen? Can they make their own food when they go to stores? Can they get around? You know, walking around Walmart or even the grocery store can be a lot of movement for people. So do they need assistance getting around stores and doing their shopping? They still may want to go out and do it themselves, but they may need one of the motorized scooters or something to get them through. And can they get in and out of the bathtub safely? If not, they may need grab bars installed or a walk in tub installed. If people are having problems with mobility because of age, because of maybe they had a knee or a hip replaced or they're on medication that makes them have more difficulty with balance for whatever reason, if they're having difficulty with mobility or balance, it's ideal to see if you can get their living environment assessed for safety. And I have a video on environmental safety assessment. But things like taping down the corners of rugs so people don't trip and fall on them can be really important. And installing grab bars. Can the person access what they need without ladders or environmental accommodations? I have in my kitchen, there's stuff on the top shelf that I cannot reach without standing on a step stool, which is fine for me for right now because I don't have any problems with my balance. But if I got to the point where I was having difficulty with that, it might not be safe for me to be up on a ladder trying to get, get the mixer or something off the top shelf. So assessing for. Can they get to what they need? If they are in a wheelchair permanently, then there may need to be some permanent modifications to the kitchen and bathroom areas and bed in order to make them accessible. If they're in a wheelchair temporarily, maybe they broke their, their femur and, you know, they can't walk on it for six months. Can they get around the house? You know, they may need assistance, they may need special tables or something brought in where they can make their food. They may need the microwave, move down onto a adjustable height cart so they can get what they need without having to stand. And, and while they're in the wheelchair, other people, it's the opposite. It's not. Well, up high can be a problem, but they may also not be able to get down low if they're in a wheelchair. You know, things that are in the bottom cabinet may be difficult to access, especially at the back, or if they've got back problems, they may not be able to bend over. You know, I've had those days where I've hurt my back and it's been all I could do to, you know, get down and get something in the front of the bottom cabinet, let alone in the back of it. So exploring and making sure they can get to what they need. Can they access their coffee, their tea, their cereal, their sweetener, their whatever it is, their toothpaste and transportation, can they get where they need to go? Are there, can they drive? You know, obviously, if they can drive, they've got transportation. If they can't drive, they've got. Do they have access to transportation either through their insurance or through their church or through friends or public transportation? If not, again, any of these things, where there's an issue, whether where there's a deficit. Reach out to United Way211 and your local community agencies to find out if they already provide that service. A lot of times these services are available, but just not well advertised. Finances. Can they pay their bills? Their electric, water, mortgage, credit card and health insurance, do they have the money to do it? There are a lot of programs that will provide assistance like once a year with an electric bill or something. And there's also services that can help negotiate with the utility companies and the mortgage companies to maybe get a payment plan if the person gets behind. But it's important for people to be able to have electricity, running water, and a roof over their head. So all of those are important. If they can't afford it, reach out for programs that can offer financial assistance and explore other options. Like maybe they used to have private health insurance, but now they qualify for Medicaid. The second aspect of finances is even if they have the money, are they cognitively able to remember to pay their bills and manage their finances? Sometimes people in early recovery from addiction, people who are clinically depressed, people who have dementia, there's a variety of things that may happen that the person is just not able to keep themselves organized enough to remember to pay their bills and manage their finances. If they can cognitively work it out with somebody, you know, sometimes the case manager may need to walk them through it. They may be able to, depending on their financial situation, they may be able to set up autopay, so at least the minimum gets paid every single month. You can also refer them out to a financial planner or a financial advisor who can help them identify strategies in order to pay their bill. And sometimes it's also a matter of putting somebody legally in charge of being able to do that, but that's like a last ditch effort. And are there extraneous expenses they need assistance with? If you're working with somebody whose pet died, for example, and they want to have the pet cremated, that may be something that's really important to them. So you may want to reach out and find out if they're his assistance with that. If they, you know, I had a friend who broke both of his legs and was in a wheelchair for quite a while, but he needed assistance building a ramp to help him get around his house. So that was an extraneous expense. It was a temporary ramp, but you know, getting assistance with that. Do they have stable housing? You know, are they in jeopardy of being evicted or are they homeless? If they have stable housing, great, check that one off. Are they planning to move? After my Mother died. My stepfather was planning to move to a retirement community. But just everything involved with packing things up and, you know, especially because that's where he had lived with my mother for the last 25 years, was just overwhelming to him. So it was beneficial to, for him. The case manager hired movers to come in to pack everything to help get him to his new place. And they worked through the process together. If you're working with families, for example, do they have sufficient space or is everybody sleeping in the same bedroom? You know, at a certain point people need a little bit of space and, and, and so assessing for this may not be something that is fixable at the moment, but it's certainly worth taking a look at, seeing if there are any modifications that might be able to be instituted, for example, to help get the infant into its own room once it gets to be old enough that the parents are, you know, wanting to do that. The person that's living in the stable housing may occasionally have repairs that need to be done on the house. Maybe the front stoop, one of the boards gets loose or the, the, the locks need to be changed or you know, who knows, A lot of times there are a lot of little handyman type things that need to be done that people may not know how to do or be able to do. Likewise, yard work is another issue as people have difficulty. If they had a hip replaced or a knee replaced, they may not be able to get out and mow their lawn. But lawn care is expensive. So volunteer services may be helpful for some people who can't afford a lawn service and don't have the support system to help them out in the interim. Long term care insurance, and I do have a video that talks about that, but a lot of times long term care insurance will pay people a daily rate and from that daily rate they can contract, purchase whatever word you want to use any services that they need. So from that daily rate they may hire a CNA to come in for two hours and they may hire somebody to come in and mow the lawn on, you know, whatever they need that daily rate is supposed to cover. So long term care insurance or volunteers can be potential sources of assistance for things like yard work and insurance. Most people have insurance of some sort, but a lot of them don't understand their policy and benefits. So it is good to be aware. And I have a video that goes briefly over the highlights of insurance and co pays and deductibles and those sorts of things so you can explain those terms to people. Sometimes if you have an insurance agent who's willing to volunteer their time. You know, it can be helpful to have a professional go over the nitty gritty. But a lot of insurance policies also have discount programs at, for eye care and health and wellness type activities that people don't even know about. So, so encouraging them to explore what benefits their insurance offers them and using in network providers, for example, in order to get their health needs met. And finally, relationally, people need to be involved in meaningful activities. We as humans, we need to feel like there's, we have a purpose. Bouncing around the house and watching TV all day may feel good for a weekend or so, but eventually, eventually when it's day after day of being isolated and doing nothing, a lot of people start getting very depressed. We need to be involved in some sort of meaningful activities. Whether that's volunteering somewhere, doing recreational activities, you know, going hiking, bird watching, doing hobbies, work supported employment. If people are not engaged in meaningful activities and they want to be, well, and they don't want to be be, you may explore whether they are experiencing significant pain or clinical depression, in which case a referral is, you know, probably helpful to a counselor or a physician. If they just don't even know what's out there. Maybe their kids moved out, they've got empty nest syndrome, you know, they don't know what to do with themselves. Encouraging them to reach out to vocational rehabilitation and see what sort of services they may qualify for. Because voc rehab is designed to help people get back to work or to work if they've never been employed. Reaching out to your local one stop career centers can be another place that people can go in order to find out about jobs that are available. And I believe it's volunteer.org is a website that tries to compile volunteer opportunities in all 50 states. So if they want to volunteer to do something, they may be able to find out, find things to do there. They can also consider meetup.com if they're interested in doing something like park cleanup. A lot of the hiking groups, once a quarter will pick a park and walk the trails and just pick up trash and things like that. So, and be creative. But if people are looking for something to do, you know there, there are ways to do it. You just need to kind of be familiar with what's available in your or in your area. And finally, obviously assessing their social support. Who do they have in their life that can provide what's called functional support, Transportation to the doctor, picking up groceries, helping them out with getting stuff out of the attic, you know, whatever they need, stuff that needs to be done. Do they have people in their family, friends, neighbors that are able to help with that. But then we also need social supports that provide emotional and social support. People that you enjoy doing things with. People that can be there when you're having a bad day, that you can call up when you're stressed out or you're depressed. That can be helpful when you're grieving. You know, all of those supports are necessary and encouraging people to try to figure out where those supports are if they don't have functional or emotional and social supports. Brainstorming with them where they may be able to connect with some of those faith based organizations, community centers, those sorts of things can be great places to connect with other people who are willing to and wanting to help each other out. Case management can occur in clinical settings, but there's also a huge demand for case management services in non clinical settings like in churches. I have another video that's kind of similar to this one on congregational care case management. A lot of churches have a congregational care pastor who could benefit from having a an army of volunteers that can provide additional case management services. Community or congregational case management programs facilitated by a paid director for continuity. If you have a volunteer director, it's too easy to lose them. If somebody's a paid in a paid position, they tend to have more longevity in the position. So a director that has a paid position can who can provide a wealth of services through a phone based program using trained screened volunteer staff. And the training can come in the form of, you know, watching the case management YouTube videos that I've got on this website and or on the YouTube website and reading information on case management. You know, it doesn't have to be a super in depth training necessarily and any in home visits such as for environmental safety assessments should always be done by people who have fingerprints and background checks on file and ideally with the caregivers present. And I say this in every video because it is important for liability protection and for the protection of abuse. We don't want vulnerable people being taken advantage of. So it is important to make sure that anyone providing services is trustworthy. Thank you for watching this presentation. As I said, there are a bunch more videos on the YouTube channel that talk about case management principles making case management more effective. You know, lots of case management topics, so feel free to peruse those and I will see you next time.