Case management
Case management (including Case Management , Case Management , borrowed from English case management ; case management or care management ) refers to a flow chart in social work .
overview
The goal in case management is well-organized and needs- based assistance tailored to the individual case, in which the care needs of a client or patient are provided. As a service, the entire support is planned, implemented, coordinated, monitored and evaluated both over a defined period of time and across the existing boundaries of facilities, services, offices and responsibilities. The case management supplements the system management, which is not related to the individual case, but to the institutions involved in the supply of the supply systems in connection with the social security systems.
The method, borrowed from social work , was initially developed as an extension of case work in the USA and in recent years has increasingly found its way into intervention strategies in social work and in the health care system , there in particular in the form of supply management according to Section 11 Para. 4 SGB V .
Most recently, case management became the central lever for the implementation of the Hartz IV laws with regard to the care and work integration of ALG II recipients. Wolf Rainer Wendt is one of the pioneers of this method .
The work as a case manager can be described as clinical social work in the preparation and support of integrated care . This professionally differentiated social work specializes in
- direct work with clients and patients
- difficult social and psycho-social disorders, social problems, and mental, somatic and chronic diseases with significant social implications
- Health work with intensive inclusion of the social context.
Basic characteristics of case management
Case management basically combines two systems to achieve the goal:
- the individual system, in which the promotion of self-management , i.e. empowerment and the strengthening of self-responsibility of the client or patient, is to be achieved through personal interaction . (Case)
- the institutional system, which deals with the coordination of material and services and the establishment of cooperative relationships. (Care)
In both systems there is a diverse need for action, support and control, which must be linked as effectively as possible to promote the client.
The case management on the "vertical", individual level takes place in different phases:
- Consulting - case taking and profiling / assessment
- Planning - target agreement and help planning
- Intervention - implementation, performance control
- Monitoring - control and optimization
- Evaluation - evaluation of results and documentation
The "horizontal" institutional system is about:
- Requirements and inventory
- Labor market analysis
- Action planning and control
- Complement the available range of services
- Expansion of the cooperation networks
- Process costs in accounting and controlling at the service provider and the cost provider
In this field of complex conditions of action, those in need of help, especially with multiple burdens, should receive assistance tailored to their individual problem in the form of a coordinated package of measures. An essential element here is the active involvement of the person concerned in the planning, target agreement and implementation and not the "planning" and management of cases.
Application of case management
The case management is basically applied according to all known books of the social security code. The applications are known for example after:
- SGB II for reintegration into employment
- SGB V for the care of patients in integrated care
- SGB VIII as a controlling specialist with a guarantor position in the context of assistance for education as a case manager of the youth welfare office or ASD
- SGB XI in the context of care advice or in the care support points
- SGB XII for reintegration into working life
- etc.
Case management functions
Case managers are assigned different functions in English literature.
Advocacy / lawyer
In the role of advocacy, the case manager stands up for the interests of his clients and informs them about their rights. As an advocate, he assists people who, in the face of conflict-prone life situations (e.g. poverty, lack of education, disability) or unforeseen biographical life crises (e.g. accident, unemployment, serious illness), are unable to defend their personal interests due to to assert short, medium or long-term individual need for help and / or socio-political powerlessness.
Broker / intermediary
As a broker, the case manager mediates between the care system and the client in an objective, impartial and independent manner. This broker or intermediary function is an answer to the confusion and disintegration of modern, complex and highly labor-based social and health systems.
Gate keeper / goalkeeper
In the role of gate-keeper, the case manager is responsible for the appropriate use of existing system resources - he controls access to the range of services and continuously reviews the selection and effectiveness of the measures taken. The gatekeeper is supposed to counteract inappropriate and non-directional use of the resources of the supply system through targeted selection and continuous monitoring. This sometimes leads to conflicting decisions. The background to the gate-keeper function is the idea that targeted access control (e.g. for patient care) represents the greatest benefit for the overall system.
Case management in practice
In the health care system, the provisions of the Nursing Act and the Heilpraktikergesetz apply. According to this, a case manager without a corresponding certificate of qualification as a nurse or without permission as a non-medical practitioner is not allowed to make any independent statements about the state of health of a patient. In all other areas of activity, case management is not subject to any legal restrictions.
The case management process
The course of the case management process is sometimes described differently by the various authors. An example here is the control loop as published by the German Society for Care and Case Management (DGCC).
- Definition by Wendt (1999):
Case management is a process of collaboration in which assessments, planning, implementation, coordination and monitoring are carried out and options and services are evaluated. In this way, a person's health needs are met through communication and with the resources available in a quality and cost-effective way.
- Definition of the DGCC (2008):
Case management is a process of interdisciplinary cooperation in patient care across all departments of a hospital and beyond. It includes the assessment, planning, documentation, coordination, organization and evaluation of health services. The individual medical and nursing needs (help and support needs) of a patient are determined and planned by the case manager with the patient. The case manager records the prospective care needs with the support of a suitable assessment instrument. The case manager accompanies the course of a patient's treatment under the aspects of quality assurance and cost control. It primarily organizes the clinic's internal processes. If pre- and post-inpatient processes are included, these are also organized by the case manager. Patient care is professional care that corresponds to the individual, professionally and scientifically recognized need, that is, “indicated”, is limited to services with adequately assured net benefits.
Organization of the facilities
In the cross-sectional dimension of case management, areas are to be linked with one another, between which there are no cooperation structures so far. Cooperation networks between the social partners of the public and private bodies have only just emerged in recent years and are often far from having long-term cooperation relationships with individual projects. The range of measures on offer is not always sufficiently expanded regionally and the labor market does not create any new jobs due to the introduction of a new method of care and placement. In 2012, case managers in health care - independent of the institutions - organized themselves as an association in order to fill this gap in regional associations and thematic groups.
Individual rehabilitation plan
The implementation of case management encounters obstacles and limits in practice. In the health care system, case management elements were introduced first in the area of rehabilitation and later also for the control of linked performance elements of several service providers in the case of protracted illnesses. A comprehensive rehabilitation plan is to be developed in which the various treatment steps from inpatient to outpatient treatment are integrated.
Case management at the family doctor
In order to save costs and avoid multiple examinations in the event of illness, the family doctor and his team should take over case management. For the effective implementation of this requirement, for example
- the patients are appropriately motivated and able to participate
- the participating teams of general practitioners are trained accordingly
- Appropriate guidelines for integrated therapy are made available
- appropriate remuneration of the family doctor takes place
- effective audits for the success of the measures are set up.
As long as the different systems z. If, for example, inpatient and outpatient therapy are insufficiently linked, this requirement remains unfulfilled. For those involved, there is additional effort as soon as different cost units are involved. This approach also excludes the social and professional environment. In addition, the variety of regulations tends to restrict, rather than encourage, the patient's initiative and activity. The effectiveness of the specification with regard to the results for the patient and for the cost bearer remains doubtful beyond pilot projects.
Rehab management
Since the mid-1990s, motor vehicle liability and accident insurers have primarily been using the possibilities of private rehab management to improve the situation of accident victims in a targeted and sustainable manner. The aim is to make the entire process transparent, comprehensible and reliable for those affected and their family members as well as the lawyers involved and the insurers as clients. The principles of this rehab management were formulated at the beginning of 2002 by the ARGE Verkehrsrecht of the German Lawyers' Association and published as a Code of Conduct. In addition to medical rehabilitation, rehabilitation management also includes occupational rehabilitation , support in the area of care , barrier-free renovation and mobility.
criticism
In German practice, the terms system management and case management are often neither defined in a meaningful way nor separated in the discussion. The duality of system (English: system ) and case (English: case ) is never explicitly mentioned. The terms and the associated responsibilities for the system and the case are not differentiated or are mixed up and mixed up. In addition, responsibility for the properties of the nested systems is not clearly borne, neither for the hospital system, nor for the social insurance system, nor for the health care system. The case also becomes a superset of the system's definition space . Elsewhere, the terms case management and case management are linguistically dissonant defined with the following recursive justification: The concept of case management is used in a wide variety of fields of social and health care. The guiding principle for the conception of the certificate course (Certificate of Advanced Studies / CAS) is the view that case management encompasses both case and system management. Or the term system appears in the text of the law as a data processing system , whereas the term case, only in legal descriptions to limit benefits, such as individual cases ( Section 7 sentence 1 SGB X administrative fee, Section 20 sentence 2 SGB X investigation principle), omission (Section 20 sentence 2 SGB X investigation principle) Case distinction and in conditional clauses with "if", otherwise , dropped out , etc.
Definition by law
The case manager initially represents the interests of his employer, employer or client. The interests of the clients or patients always remain subordinate. The role of the case manager is just as undefined as the task in case management.
The term case manager is not used in German legislation in connection with social work.
Appropriateness of the decisions of dependent case managers
As a result of the largely open performance obligation before laws, ordinances and administrative regulations that can be interpreted widely, the implementation of audits in accordance with EN DIN 19011 on case management services in Germany is hardly to be expected. The increasing number of lawsuits before the social courts is a clear indication of this.
Enforcement of a legal claim
The problems in service law with poor performance were dealt with for the first time more than 130 years after the introduction of the German Civil Code with the renewed law of obligations (see §§ 280 ff. BGB, compensation for breach of duty), although this hardly remains applicable to public institutions within the scope of the Administrative Procedure Act. Thus, the task of the case manager, as well as the objective of the case management, has not yet been defined in a court-proof manner and therefore no quality of care can be claimed for the individual case.
Observation, review and auditing
The usual in American organizational units functions of observation (English: monitoring ), surveillance (English: surveillance ) and auditing (EN ISO 19011) degenerate in the German practice to superiors and to the exclusive binding to the responsible management entity. An independent review of the successes and the quality of the work in case management has therefore not been established.
Criticism of the employment promotion
In the area of employee promotion within the framework of Hartz IV implementation, case management is initially discussed with a further claim. Problem areas are also clearly recognizable now. Employees entrusted with case management in the employment agency or the social administration of the municipalities need far more freedom of design and decision-making for this task than for their previous work. Additional qualifications, supervision and a supportive working atmosphere are indispensable, including superiors who recognize and support the purpose and demands of the process.
Criticism of the system of flat rates per case
Except in the common word component fall , the case flat rates remain beyond case management. They only serve to control billing after a service has been provided and do not even affect the booking . The coder who deals with the case flat rates has nothing to do with case management.
See also
literature
- Schmid, Elmar; Weatherly John N .; Meyer-Lutterloh, Klaus; Seiler, Reiner; Lägel, Ralph: Patient coaching, health coaching, case management - methods in the health management of tomorrow 1st edition, MWV Berlin, 2008 ISBN 978-3-939069-29-4
- Ewers, M. / Schaefer, D. (Ed.): Case Management in Theory and Practice , 2nd edition - Bern: Huber Verlag 2005.
- CMSA - Case Management Society of America: The Standards of Practice for Case Management , Little Rock (USA) 1995.
- Kleve, Heiko u. a .: Systemic case management. Case assessment and help planning in social work , Aachen 2003 (1st edition), Heidelberg 2006 (corrected new edition).
- Löcherbach, P u. a .: Case Management , Munich 2003.
- Neuffer, Manfred: Case Management. Social work with individuals and families , Weinheim, 3rd revised edition 2007.
- Wendt, Wolf Rainer: Case Management in Social and Health Care. An introduction , 5th edition, Freiburg 2010.
- Rütz-Lewerenz, Günter; Thäsler, Gerhard: New methods of control in the social and health sector - or: How case management leads to a confusion of roles. In: Harald Pühl (Ed.): Handbook Supervision and Organizational Development; 3rd updated and expanded edition, VS Verlag für Sozialwissenschaften, Wiesbaden 2009. ISBN 978-3-531-15877-8
- Brinkmann, Volker (Ed.): Case Management - Organizational Development and Change Management in Health and Social Enterprises, Gabler Verlag, Wiesbaden 2010
- Pflügel, R. et al. 2009: Experience with change management: The introduction of case management in hospitals. In: Beherend, König, Krystek (Ed.): Aspects of the change in hospital management. Springer publishing house
Web links
- Literature on the subject of case management in the catalog of the German National Library
United States
Germany
- German professional association for social work, social education and curative education eV
- "Case Management" journal, HJR-Verlag, Heidelberg
- Case management in social work with people with legal support
- German Society for Care and Case Management eV
- Case management and multi-perspective case work in socio-educational work with adults - differences and similarities
- The Case Forum for Management in Health Care eV is the first German case manager network - the association was founded on September 26, 2012.
Switzerland
- www.netzwerk-cm.ch Network Case Management Switzerland
Individual evidence
- ↑ Objectives of case management (PDF; 1.9 MB)
- ↑ Case management concept of the employment agency ( memento of the original from November 22, 2008 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 390 kB)
- ↑ Case Management according to SGB V
- ↑ reintegration into working life
- ↑ Wendt WR: (1999): "Case Management in Social and Health Care - An Introduction". 2nd edition Lambertus, Freiburg
- ↑ Definition of the DGCC ( Memento of the original from July 14, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. ( MS Word ; 474 kB)
- ↑ Case management by medical assistants improves the success of the therapy
- ↑ Code of Conduct. (No longer available online.) In: www.verkehrsanwaelte.de. Archived from the original on August 11, 2016 ; accessed November 30, 2016 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Title System Management in Case Management ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ Ontology error English-German ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ Klageflut SGB II ( page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ Klageflut SGB V ( Memento of the original from January 4, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
