The Case Manager
Do you ever wonder what happens to the patients you provided case management services to over the years? As nurse case managers, we work with many people, but once a case closes, we often lose contact.
Last week, I heard from a gentleman I had worked with over the past four years. I’ll call him Troy. He sustained a catastrophic injury while living in North Dakota that left him a quadriplegic. Unable to care for himself, he was discharged home to his family who agreed to care for him.
After returning to Florida, one of his friends contacted me and asked if I could help. The family was overwhelmed and needed help. Troy was only nine months post-injury and was completely dependent on his family for every aspect of his daily care. I agreed to help, and that conversation marked the beginning of a long professional relationship as his nurse case manager. Because he had no financial resources, I provided my services on a pro bono basis.
Together, we developed a plan of care and prioritized his immediate needs. The first priority was healthcare coverage. Although he had private insurance while he was working, he now needed to apply for Florida Medicaid after becoming permanently disabled and relocating to another state.
Getting him to medical appointments was extremely difficult, so I searched for a nurse practitioner who could serve as his primary care provider through home visits. This proactive approach helped identify problems before they became crises. I also arranged for a durable medical equipment supplier to deliver his medical supplies each month. Those were only the first of many needs we addressed together.
Throughout this journey, I worked closely with his sister, his first caregiver, helping her learn how to care for him by coordinating home health services whenever additional support was needed. She taught herself how to successfully treat the Stage 4 pressure injury he came home with, learned to manage his suprapubic catheter to reduce urinary tract infections, and developed a bowel program that significantly improved his quality of life.
Eventually, Troy moved into the home of a friend who became his primary caregiver. She seamlessly assumed his care, building on everything his sister had learned. I was continually impressed by these two women, neither of whom had any healthcare training, yet both provided exceptional care through dedication, determination, and a willingness to learn.
We also explored community resources that could improve his independence. Through local organizations, we obtained home modifications and equipment that were not covered by his Medicaid or Medicare Advantage plans. Looking beyond traditional insurance benefits and identifying community resources became an important part of helping him build a better life.
As we continued working together, Troy gradually learned to advocate for himself. I encouraged him to speak up, ask questions, and not be intimidated by healthcare professionals or insurance representatives. Using the two functional fingers on his good hand, he became remarkably skilled at researching information on his phone and learning about his condition.
Whenever possible, I included him in phone calls I made on his behalf. He listened as I spoke with vendors, insurance representatives, physicians, and other healthcare professionals. Over time, he learned not only what questions to ask but also how to clearly explain his needs. Eventually, he became an effective advocate for himself and successfully navigated many challenges independently.
As the years passed, I intentionally stepped back and encouraged him to resolve issues on his own whenever appropriate. He was ready. Although he often said he wished he didn’t have to rely on Medicaid, he accepted that it was his reality. Like many people with chronic disabilities, he found the healthcare system confusing and fragmented. Together, we worked through those challenges, and he learned that persistence, preparation, and self-advocacy often lead to better outcomes.
He would have given anything to return to work and leave this chapter of his life behind. He understood that wasn’t possible, so instead he focused on building the best life he could with the circumstances he had.
When Troy called me last week, I was genuinely happy to hear from him. He updated me on everything that had happened over the previous several months. He shared that he had recently been hospitalized with a severe urinary tract infection but was recovering well. As we talked, I realized how confidently he is able to manage his health and healthcare. Years ago, many of these challenges would have overwhelmed him. Today, he knows how to navigate the system, ask the right questions, and seek the resources he needs.
That conversation reminded me that effective case management is about much more than solving today’s problems. It is about equipping people with the knowledge, confidence, and skills they need to navigate tomorrow’s challenges.
“The lesson this experience reinforced for me is that regardless of your practice setting include your patients and their caregivers in every conversation and every decision whenever possible. Explain what you are doing and why. Model effective communication. Teach them how to ask questions, solve problems, and advocate for themselves instead of doing everything for them.
One closing thought: Throughout my career, I’ve often told case managers that our job is to ‘work ourselves out of a job.” Every case will eventually close, but the impact of what we teach should continue long after we’re gone. If we’ve helped someone become a confident self-advocate who knows how to navigate the healthcare system, then we’ve achieved one of the greatest outcomes our profession can offer.
Thanks for all you do!
