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August 14, 2016

Case Management: Monitoring Services

Monitoring services is yet another key case management duty. The monitoring phase is usually the final phase of the case management process that occurs after you have made the referral (linkage) and coordinated services that are now in place. The monitoring phase, in my opinion, is the easiest (or less difficult) aspects of case management. Monitoring is basically ensuring that services are delivered as specified on the treatment plan and that the client is satisfied with all services. Case managers also monitor for safety and are  mandated to report any suspected abuse or neglect. Although case management services may differ slightly depending on the program and state, a monthly contact of some kind is usually required to monitor services (and bill Medicaid of course). There are several methods case managers use to monitor client services and overall progress on treatment goals.

Phone Call: The basic phone call remains the primary form of contact. Based on my personal caseload, I would say that about 60% of my monthly contacts are by phone, 30% face to face contact, and about 10% other (email, text, fax, etc.). Again, this is based solely on my personal experience.

Face to Face Visits: The face to face contact is the second most frequent form of contact behind the phone call. However, constant revisions in regulations have resulted in an  increased emphasis on face to face contact. The face to face contact is probably the most effective form of monitoring services. Case managers can directly observe clients at home, work, or day programs and make more accurate assessments on their progress. Case managers can also observe any physical changes from the last visit such as grooming, health changes, weight gain/loss, or signs of illness. The unannounced visit is really the best type of visit if you want to get the most accurate assessment of client services. However, high caseloads make it difficult to just “pop in” without verifying that the client is at the program. Unannounced group home visits are also difficult with caseloads that can range from 25 to over 50 clients.  Time is at a premium and most case managers cannot afford a wasted visit.

Email: Email is slowly becoming a more accepted form of contact. The security of email remains a major concern its usage as a primary form of contact. Emails between the same agency is usually acceptable but is not recommended outside of the agency unless it is a secured type of email that requires a separate user name and password.

Letter: Letters or other written forms of contact are often used as a last resort when other attempts were unsuccessful. Some case managers send out letters as a courtesy when there is going to a change in case manager so there client and family can be informed. Letters are used the least of all forms of contact largely  due to postage costs and the time it takes to deliver the information. It’s much faster to send an email or fax when you want to send a letter or other form of written communication.

Contact with Family
Case managers are in regular contact with family to ensure that services are received as agreed on the treatment plan. This is particularly important if the client is receiving ongoing services in the home such as skilled nursing or personal attendant care.  It’s also important to follow up after other services have been provided in the home such as environmental modification (ramps, railings, etc.) or assistive technology (specialized beds, IPads, etc.) to ensure complete satisfaction.

Contact with Providers
Regular contact with providers is another way that case managers monitor services. Case managers receive regular updates on progress and can address any concerns that may arise.  Case managers often monitor progress in day support and vocational programs through contact with the service provider or the employer. Case managers also maintain regular contact with residential providers to ensure that the client is happy with his home and address any concerns or needs.

Reviewing Documentation
Another form of monitoring services is the reviewing of provider reports and other documentation. This form of service monitoring is often forgotten because it doesn’t involve direct contact with the client, family, or providers. Case managers routinely review quarterly reports, treatment plans, and incident reports to monitor progress and address any concerns.

The monitoring process is critical in maintaining service quality as well as the overall health and safety of clients. After services are in place, case managers spend most of their time monitoring and documenting satisfaction and/or dissatisfaction with services.  Case managers are basically on the frontline in the regulatory process. They interact with the clients and service providers more than any other agency, including state licensure.

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