Disability Is Not Just a Health Problem: Case Management

Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions.

An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations.

Disability is thus not just a health problem.

It is a complex phenomenon, reflecting the interaction between the features of a person’s body and the features of the society in which he or she lives.

Overcoming the difficulties faced by people with disabilities requires interventions to remove environmental and social barriers.

Disability Case Management – What Is It?

The terms “Disability Case Management”, “Case Management”, “Rehabilitation Case Management”, and “Vocational Case Management” are sometimes used interchangeably within the disability management industry.

They may or may not mean the same thing, however, depending on the system in question (Workers’ Compensation systems, long and short-term disability insurance providers, auto-insurance, self-funded employers, government assistance programs, etc.).

Case management encompasses a wide range of activities; therefore, it is challenging to define case management as a discrete intervention precisely.

Disability case managers working on behalf of an employer for example focus exclusively on absences from work as a result of illness, injury, or disability, and on preventing the risks that cause these absences.

It is a deliberate and coordinated effort by employers to reduce the occurrence and effect of illness and injury on workforce productivity and to promote employee attachment and retention, as well as early return to work.

Case Management within the context of a Long-Term Disability (LTD) insurer, on the other hand, may share the ultimate goal of a return to work but in a broader sense (own occupation as well as any occupation), and may have more of a long-term vested interest in optimizing a disabled individual’s potential.

In this sense, an individual’s “rehabilitation potential” may be defined differently depending on the needs and policy parameters of the system in question, and as such, the role of “case management” may vary accordingly.

An individual can also be considered to have rehabilitation potential within one system and not within another.

In a literature review, Lukersmith et al. cited 79 articles that identified 22 definitions of case management, described five models, and delineated 17 key components of case management comprising 69 activities and tasks.[1]

This variability in both the definition and description of case management may lead to a vague sense of case management in a given initiative.

It may also contribute to potential role confusion and ambiguity among those who conduct case management activities and tasks.

The 17 key components identified in the literature review included [1]:

  • case finding
  • establishing rapport
  • assessment
  • planning
  • navigation
  • provision of care
  • implementation
  • coordination
  • monitoring
  • evaluation
  • feedback
  • providing education and information
  • advocacy
  • supportive counseling
  • administration
  • discharge
  • community service development

Major Focus of Disability Case Management

It is a well-known rehabilitation tenet that the safe and timely provision of appropriate services to people with impairments is more likely to reduce the impact and implications of those impairments in the longer term.

The philosophy underlying Case Management, generally speaking, is the notion that when we help individuals achieve their highest level of functioning, earlier rather than later, it is beneficial for all those involved in the process: the client, service providers, and the healthcare/insurance systems.

By increasing an individual’s level of functioning, autonomy, and capabilities, Case Management not only ensures an optimal level of independence for disabled individuals, it also ensures the timely application of services in a fiscally responsible and optimal manner.

The Role of a Disability Case Manager

The role of case management is to enable a person to access life in a way that is congruent with their abilities.

Regardless of the system in question, however, Case Managers are responsible for managing care and intervention services for disabled clients that they will need in order for them to return to work and/or optimal functioning.

They work closely with individuals to identify goals for improvement and in identifying needed supports and services which focus on improved physical, mental, emotional, and/or vocational functioning.

They communicate regularly with all key stakeholders, partner with physicians and allied healthcare providers, coordinate return-to-work planning, monitor progress, and provide support.

They also take an active role in procuring necessary intervention services such as mental health support, additional physical treatments, upgrading, retraining, etc. by representing the individual’s rehabilitation needs to the referral source in an objective manner and in line with best practices.

In order to provide the best and most appropriate services possible, Case Managers interview clients, review their health records and speak with medical and mental health professionals in order to develop a picture of their client’s needs.

Once a determination has been made as to the type and level of services required, disability case managers contact the appropriate care providers to initiate a program of care.

Once a client is receiving care, case managers then continually review the care received in order to ensure that the level of care is appropriate.

As changes occur in a client’s level of functioning, disability case managers adjust the care plan to better address the client’s needs.

By reviewing and assessing disability with an aim to provide the most appropriate services to those who require it most, disability case managers act as a point of liaison to ensure an individual’s physical and mental health needs are met by ancillary services.

Steps towards patient independence and improvement of function are key objectives of the role.

What Are the Services Offered in Case Management?

Services offered in Case Management can include:

  • Comprehensive Assessment
  • Implementation and Co-ordination of a multi-disciplinary community individual rehabilitation plan (IRP)
  • Work to ensure timely access to goods and services
  • Direct support in the areas of:
    • education about the nature of the impairment
    • support and education to caregivers and/or the person’s support network, as appropriate
    • development of self-management strategies
    • encouragement, emotional support, and motivation
    • development of social support networks
    • development/maintenance of abilities relating to activities of daily living and return to work.
    • referring to and accessing other desired/needed community and primary healthcare services
    • Obtaining approval for funding

Disability Case Management Services may also include:

  • the creation of a community rehabilitation team following hospital discharge for catastrophically disabled individuals
  • the coordination of medical and specialist appointments
  • acting as a liaison between the individual, the medical community and the rehabilitation team, the employer, and the funding source
  • coordinating each step towards returning to work, school and/or independent living
  • exploring vocational placements and reintegration into the community and the workforce

How Multi-Disciplinary Collaboration Improves Case Management

Case management, owing to its focus on coordination, is inherently rooted in multi-disciplinary communication and teamwork.

An effective case manager must facilitate communication among various disciplines to develop a plan of care that is inclusive of the many fields that are typically involved in the care of an individual.

It is especially important in those patients/clients with chronic conditions or who find themselves in circumstances where they frequently utilize healthcare services.

The case manager must interact with a wide range of patients/clients from various backgrounds, have a wide range of capabilities, and access varying family and community support levels.

The fundamental ingredient to case management is the planning of care, which results in a care plan that essentially is the roadmap for a given patient/client to navigate through.

The benefit of effective and hands-on Case Management is that it creates a continuum of coordinated and monitored service provision aimed at meeting the evolving needs of the individual over time.

It facilitates the seamless transition of the person from one stage of their recovery to the next, based on forward planning and regular review.

Case management also creates a continuum of support and service provision through the adoption of a holistic approach that engages multidisciplinary inputs in a coordinated way to meet identified needs.

Case management assists all stakeholders in identifying an individual’s needs through a flexible set of assessment procedures, accessing appropriate service responses within the community, and monitoring the outcomes of interventions on behalf of the individual and referral source.

It is noted in the literature that positive outcomes in case management intervention tend to include high-intensity interventions (i.e. when there are small caseloads, frequent and ongoing communication, and when multi-disciplinary and inter-organizational plans of care are part of the intervention).

At the end of the day, effective case management can actually reduce the level of disability that a person ultimately experiences.

In fact, the growth of case management as the approach of choice to deliver safe and timely interventions to individuals experiencing illness or injury has been gradual but consistent over the past few decades in Canada, and the benefits over time to insurers, employers, and disabled individuals have been self-evident and significant.

John Drudge, President

Rapid Interactive Disability Management (RIDM)


Citation [1]: Lukersmith S, Millington M, Salvador-Carulla L, What Is Case Management? A Scoping and Mapping Review. International journal of integrated care. 2016 Oct 19;     [PubMed PMID: 28413368]

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