The work of long term care case managers : the two faces of case management
Date
1997
Authors
Goodwyn, Sherry Elizabeth
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Abstract
This study examines work of Long Term Care Case Managers in British Columbia, Canada. Long Term Care is a publicly funded program. That program's mission is to care for chronically ill adults. This care includes allocation of resources such as homemaker services, adult daycare and care facilities. The everyday lived experiences of Case Managers were the entry point to exploring their work. Ethnographic methods were used to collect data including observations of work with clients and caregivers, interviews of Case Managers, and documentary analysis.
The research revealed two facets of Case Managers' work. One facet is the completion of paperwork to meet the organization' s need to be accountable. Standardization of people, both clients and Case Managers can be seen as the effect of completing LTC documentation. 'Pixel reality' named for the smallest
square of light on a computer screen, is the ultimate outcome when information on LTC documents is computerized. The documentary process strips information from having any resemblance to a real person. However, this stripped-down information is used to make budgetary decisions that dramatically affect the life of real people.
Diametrically opposed is the second facet of Case Managers' work involving support for caregivers/clients. The unpaid caregivers who are shown to be the primary focus of Case Managers' work, do 80-85% of the work of caring for the L TC client. These unpaid caregivers also do some of case management such as monitoring and assessing clients' needs. This uptake of work by families enables LTC Case Managers to ' manage' caseloads of 200 -300 clients.
Case Managers are the human link necessary to adapt the formal Long Term Care program to meet the needs of the unpaid informal caregivers. Analysis of ethnographic field notes revealed work by Case Managers to maintain the delicate balance between allocating scarce LTC resources and "propping up" caregivers to continue their participation in client care thereby fulfilling the mandate of Long Term Care. All of Case Managers' work, the visible documentation and the invisible support of caregivers is essential to meet goals stated in the mission statement of Long Term Care.