Case Managers Are Voice for Vulnerable Members and Their Families
Vicky Reilly knew her mother’s mental health was declining. And she knew her brother and sister-in-law needed a break from caring for the 84-year-old woman in their Florida home. But Reilly was hundreds of miles away in Pennsylvania, and her mother, Betty Donley, had just been discharged from an in-patient procedure.
After a couple phone calls with Lisa Chatman, a registered nurse case manager with the Florida Blue Readmission Prevention Program, it became clear that Donley needed help beyond appointment scheduling and medication management. Chatman quickly reached out to her colleague Jessica Kuilan to discuss some possible opportunities for behavioral health support.
“That’s when the relationship evolved,” Chatman said.
She and Kuilan, who is a clinical social worker, reached out to New Directions Behavioral Health to get the ball rolling. They were able to quickly connect Donley to a psychiatrist and, for several weeks, she was doing really well.
But there was still work to be done.
Donley was still living with her son and daughter-in-law, and her mental health was beginning to raise safety concerns for her and others.
Meanwhile, COVID-19 was adding to an already stressful situation. Resources were limited and the pressure to find a permanent solution for Donley was building.
“It wasn’t safe for her to be at home anymore,” Kuilan said. “But that’s a very difficult conversation to have and it’s a very difficult decision to make for a loved one.”
In addition to the coronavirus, Donley’s condition was making it even more difficult to find an assisted living facility that fit her needs. And Reilly, at the time, was not the legal guardian of her mother, which also presented other challenges.
“It was so incredibly emotional for everyone,” Kuilan said. “But (Reilly) knew she could always contact us. Being there and being that mediator; that supportive factor for members and families is so important.”
With the help of Chatman and Kuilan, Donley now lives at a skilled nursing facility where she is happy and able to get the care she needs. And Reilly was able to use the resources provided by Chatman and Kuilan to obtain legal guardianship.
Reilly told Kuilan she doesn’t know what she could have done without them. “It’s really hard to navigate the health care system. Especially when your emotions are wrapped up in it,” Kuilan said.
But luckily for Donley, navigating the health care system is what Chatman, Kuilan and so many other Florida Blue case managers and community specialists love doing.
“We just love helping people and being that person that they reach out to for support,” Chatman said. “And even if they can’t directly assist a member, Chatman says it’s about doing the work to get them to the right person.
“We are the voice for our vulnerable population,” Kuilan said. “Sometimes we are their lifeline and the ones they count on. We have to work together to make sure their needs are met.”
Filed under: Medicare