Meeting the challenges of catastrophic care

elebrities have an unmatchable ability to focus the public's attention on specific problems or events. No w o n d e r charities and causes look for celebrity endorsements and support to spread their messages to the masses. Look at Christopher Reeve. His struggle as a person with spinal cord injury (SCI) has been documented on an ongoing basis in the media. I cheered for him w h e n he learned to breathe off the ventilator for short periods. I watched him on TV giving interviews and followed his progress with the rest of the world. I was ecstatic w h e n I heard he was on the speaking circuit, a n d n o w he has directed a movie. What an inspirational story! However, his story is not so different from those of the estimated 183,000 to 203,000 persons in the United States with SCI. Catastrophic case m a n a g e m e n t was the first type with which I became familiar w h e n I started working with The Case Manager back in 1990. I've seen so m a n y changes in the profession and the scope of cases with which case managers work that it's easy to forget about our roots to focus on the "new" developments a n d market trends. However, catastrophic case management is still a large part of the case management picture. Just look at a few statistics. The National Spinal Cord Injury Statistical Center in Birmingham, Alabama, reports: 9 The a n n u a l incidence of SCI is between 7600 to 10,000 n e w cases. 9 Approximately 57% of SCIs occur a m o n g persons between 16 and 34 years old. 9 Historically, m a n y persons with SCI were forced to live the remainder of their lives in institutional settings, such as nursing homes. Today, 89.2% of all persons with SCI who are discharged alive are sent to a private, noninstitutional residence (in most cases their own homes).

TCM 4

May/June1997

What do these statistics mean for case managers? Case managers m u s t have a long-term, global v i e w of care. They should not look just at what is the "quick fix" for today in terms of short-term savings b u t also what the long-term needs a n d cost benefits may be. Case managers m u s t stay knowledgeable about h o m e medical equipment. More persons with SCI are living at home, and technology has made it easier for m a n y of them to be self-sufficient a n d active at some level. Case managers m u s t stay current on therapies, drugs, and other n e w information related to SCI. The Internet and other consumer-oriented information sources have made it possible for persons with SCI to be more knowledgeable about their condition and treatment developments. Case managers must be able to focus on family and caregiver-related issues. Between managed care shortening lengths of stay in acute care facilities and technology making it possible to give more care at home, much of the daily caregiving falls to family members. Catastrophic cases affect not only the patient but also everyone who lives and works with that person. Case managers must learn more about aging issues and h o w they relate to SCI. Again, medical technology is making it possible for patients t o live longer, and case managers will have to include complications brought on by the aging process in care planning. Christopher Reeve and all the other supermen and s u p e r w o m e n with SCI are counting on you!

Nathania Sawyer Managing Editor, The Case Manager