16 minute read
SUPPORTING CLIENTS AND FAMILIES
The importance of working with clients and their families
While the role of the case manager is to support their client, the involvement and needs of their partner and family can be fundamental to the situation being a success.
Advertisement
Here, Virginia Bowley, case manager with ILS Case Management, discusses how this can be difficult to achieve – but the end result can be hugely beneficial for all parties
Being a case manager, I have often wondered how I would react to having health professionals coming into my life and talking about many aspects of my personal and private life, with the details then being reported to others. What would it be like to give up any control over what I did because someone else thought it might benefit me? How would my partner react to time-consuming meetings and frequent contact with the case manager and other health professionals? This is what our clients have to go through when they instruct a solicitor to pursue a claim for personal injury. On one visit, many years ago, I was told that the couple only faced up to the reality of what had happened when I visited. They otherwise tried to mask the enormity of the change in their lives and lived tandem lifestyles which left the client feeling isolated by his wife and not supported.
From high-flyer to carer
I worked with a client who sustained a spinal injury and whose wife had a very well-paid senior role. She was used to being in charge of matters and delegating tasks to others. She enjoyed her job and had worked hard to achieve her position. When her husband was injured, she wanted to be as involved as possible in his care and support which jeopardised her work prospects. As a result, she reluctantly decided to leave her job. She made this decision with real sadness, and it was a source of deep frustration for her. I quickly needed to ‘tune in’ to what the client’s wife needed from me as the case manager. She was highly organised, time focussed and, frankly, quite intimidating! I decided to have a meeting with her to talk about what aspects she wanted me to do, and which she wanted to be in control of. I realised, to make this work and to avoid duplication of tasks, that excellent communication between us was of key importance. The client was struggling to come to terms with his catastrophic injury and sadly became very depressed, as a result it was difficult for him to engage with anything proposed. His wife was very keen to find something that might capture his attention and help him in his recovery. The difference in their personalities was stark. Given that I was my client’s advocate, and that I was not working for the client’s wife, I needed to reflect on what approach I needed take to effectively move things forward. We decided to work on hobbies that the client previously enjoyed, and with the help of an Occupational Therapist, agreed goals were drawn up to help him overcome the barriers he was now facing in doing what he used to enjoy. Thankfully, we were able to establish a working relationship where the client’s wife felt supported by me as case manager for the benefit of her husband’s rehabilitation.
Anger needing to be managed
On another case, my client was a father of four children. He was living with extreme pain following a road traffic accident in which he was injured. Despite being safe to be left on his own for short periods, he demanded that his wife stayed with him rather than go to work. His children were not allowed to have friends in the house, for fear of him becoming angry with them, and he had a low tolerance to auditory stimuli meaning that the TV and any other form of noise had to be kept to a minimum at all times. The controlling behaviour had a devastating impact on his wife, who eventually stated that unless he accepted paid care support, she would leave him. The anguish my client’s wife was feeling was clear to see, as she had aspirations to progress her career in the educational field. However, the anger and determination in my client was also evident as he seemingly wanted to keep his wife from having any freedom. I had to carefully navigate my way through their seemingly unsurmountable differences in order to get the best result for my client and his family. It took time to resolve, but the wife’s ultimatum stirred my client into action and he did begin to realise that not only would he have lost the life he used to have, but he stood to lose his family as well. He reached a point where he was able to accept the importance for his wife to be able to return to work part-time, and he agreed that we could arrange for external paid carers to support him whilst she was at work.
Breaking through barriers Overcoming resentment Understanding grief
When I volunteered for Cruse Bereavement Support, I studied how grief can affect us, and through my work as a case manager, I have observed that clients and their partners all appear to go through the different stages of bereavement for many years after the accident or injury has occurred. In my role, I have always found it beneficial to take time to ‘tune in’ carefully to the dynamics of the relationship between clients and their partners and loved ones whenever I am in contact with them. Often, an email from a client’s partner can sound like there may be more they want to say, but they cannot or will not commit their thoughts to writing. In such cases, I will call them to allow them to talk things through more freely, and this gives me an opportunity to gain a clearer understanding and gauge what is troubling them. It can also convey the important message that as the case manager, I am eager to have as good an understanding as possible of the depth of feeling that both clients and their partners have. I often explain that if partners can say how they are feeling it can free up the client and others to speak more openly.
I have also worked with a client who required 24-hour care. He understood and accepted the need for care, but his partner constantly denigrated the staff and criticised their work. The client enjoyed an active social life often staying out very late which the carers accommodated. However, when it came to escorting the client on holiday to a music festival, the client’s partner stated clearly what she wanted to do with the time away which differed from the client’s expectations. This caused tension within the care package as the client wanted to experience the festival environment with his partner, which she did not always want to do. I worked closely with the team leader to try and resolve the issues raised by the partner, but there was always a deep sense of resentment from her regarding the cost of the staff, and a sense that she did not value them. I reflected on this and decided to talk to the partner to try and break through the barriers to her having a harmonious working relationship with the care team. It was a subject that required re-visiting several times and the care team required much support when they felt undervalued. However, through ongoing conversations and sensitively raising the issues with my client’s partner, progress was made and tensions between her and the care team gradually lessened. Another client I have worked with lived with his girlfriend who had become his full-time carer. She had become deeply resentful of how she was being treated by him and decided she wanted to leave. My client desperately wanted her to stay, but the more he tried to persuade her to do this, the more aggressive he became, which had the effect of pushing her further away. My task was to reduce the highly volatile feelings that were developing whilst not aggravating my client who had a quick temper. I could see the desperation in his partner’s demeanour, and could sense the sadness in my client when he realised that he had shown no respect for his girlfriend and had treated her so poorly. He was so keen for her to reconsider and stay. Sensitive and timely discussions had to take place with both my client and his partner to enable them to both feel supported, listened to and to enable a way forward for them both.
Supporting couples to become stronger
Through my 20 years’ experience of working as a case manager with clients who have partners and loved ones, I have found that it is essential to ease into the relationship respectfully, to actively listen to their concerns without judgement, and to be mindful of the language I use to ensure it is not alien to them. Over the years, I have learned of the importance of working at the client’s pace and to give them and their partners time to come to terms with a different way of living that might be very difficult for them to accept. As case managers, we may well have a vision of how therapeutic interventions and care and support could help our clients, but they are often managing pain, confusion, discomfort, immobility, loss of freedoms and social isolation which can result in a variety of reactions to case management which always demands careful consideration and an open mind.
Established to make a difference to the lives of people living with complex needs, Premium Care Solutions has grown to support clients across the country in living in their own homes, finding solutions to the many challenges that may present.
NR Times finds out more about the business, its focus on independence, and how and why clients are central to everything it does From a desire to promote independence and enable people with even the most complex needs and disabilities to remain in their own homes has come a fast-growing national care provider which is dedicated to putting clients at the core of its whole operation. Premium Care Solutions (PCS) supports people across the UK in being able to live as independently as possible, assembling a bespoke care package and hand-picked care team to deliver exactly what the client needs to be able to maximise their potential and enjoy their life. Since its foundation in 2005, PCS has expanded from its base in Kettering to work with commissioners on a national basis, enabling people living with the most complex of care requirements - often requiring 24-hour care - to be discharged from acute or rehabilitation settings to live in their own surroundings. Established by brother and sister team Amrit Dehal - managing director of PCS - and clinical director Jin Garcha, the care provider benefits from the expertise and insight of lawyer Amrit and Jin, who has over 30 years’ experience in healthcare, who jointly share a commitment to doing all they can to deliver a truly client-centric service. And a key part in doing so is how PCS assembles each care team. Every team - which works solely with one client, routinely over the course of many years - and each member within it is chosen based on the final say of the person they will be supporting. “I think so many people have a vision that they want to be in their own home, their own environment, and that’s what we want to do for them. We want to enable that to happen in as many situations as possible, no matter how complex their needs,” says Jin, who has worked in complex care for over 22 years. “We are absolutely committed to doing all we can for every client, we’ll always go above and beyond. If there’s something they want to do, we’ll look at every way we can make that happen. If a client wants to go on holiday, then whatever challenges we face in doing so, we’ll bust a gut to get them on holiday. “Life is for living - and that’s what we want to help our clients to do.”
Client-focused care
Back in 2005, seeing the lack of dedicated, bespoke support for clients with particularly complex needs in being able to live in their own home, Amrit and Jin took the decision to create a specialist provider which would deliver exactly that. “We saw the gap in the market, we felt we could do something different and a little bit better,” says Jin, who also has experience in case management. “Providing a really bespoke service that is one-to-one and tailor-made for the client, so they can get the best out of their life and achieve what they want as far as possible, was what we really wanted to do. “Being at home is a big part of that for so many people. Being able to achieve going back home might seem unlikely in some situations - but we wanted to do absolutely everything we could and look at every option so that it could be possible. “If they can’t return to the home they used to live in, then we’ll work with the MDT in finding their ‘forever home’ and moving the team over there. That’s the next best thing and gives so much more independence than being in residential care, which is very important to clients and their families.” Developing a specialism in supporting people living with brain injury and spinal cord injury - the business is a trusted partner of the Spinal Injuries Association, among other endorsements - PCS assembles expert teams to handle the most complex of requirements, from ventilator dependency to trachaeostomy care. It also has a dedicated service for young people. And it is the delivery of such specialist care, and the way it goes about it, which PCS believes is so important in how it works with clients. “We will always do all we can to get any client home and will assemble the team to support that. Very often, we’ll support the client for life, so we want to get everything in place for us to enable that,” says Jin. “We say we put the client at the centre of what we do, and that’s what we do. It only works if the client completely gels with a member of staff and has had a say it who's going into their own home. to client care. “We're not hands-off managers, we're very hands on,” says Jin. “We visit our clients very regularly, we’re frontfacing managers because we believe that staff and clients both need to see us and see our faces. It’s never ‘Here’s the team, now off you go’ and we move onto the next one. “Our manager-to-client ratio is typically about eight clients per manager, we don’t have big case loads. We believe if you have a smaller case load, you’ll get a better quality of care.” Training is also a key feature in delivering the service it does, says Jin. “We do all of our own training in-house, nothing is outsourced,” she says. “There is classroom training, hands-on training, we do the clinical competencies to make sure they understand the individual’s needs. It’s quite robust and in-depth, so that every member of staff is completely geared up to totally understand the situation they are working in. “If a client is spinal cord injured, they’ll come to understand the components of that injury; if they have a brain injury, they’ll understand the components of a brain injury and how that affects that individual on a day-to-day basis. It’s very bespoke to each client, because each injury can affect different clients in different ways. “Our care packages are nurse-led, and we’re very clinically-focused, we have a lot of clinical oversight of our teams from in-house support.”
For a full package, there could be anything between six to eight people on their team to cover a 24-hour care package, so they need to be involved in knowing who these people will be. “We will go and visit the client first, to get an understanding of who they are and who they would like on their team. We’d never just recruit without the client being involved. “Each team is recruited specifically for that client, we won’t send that team to other people. We’ll look at matching interests with the client - have they always enjoyed gardening, or reading, or whatever else it might be? We’ll look for what similar interests we can find and try and recruit on that basis. “We have three stages to our recruitment process - we do telephone screening, video screening, and then at the last stage, we’ll put those individuals in front of the client. They get to meet them before we complete the process and they always get the last say.”
Making a difference
Established to make a difference in the marketplace, what does PCS believe makes it stand out from the crowd? Jin points to its commitment to quality. “I know anyone can say that, and I do feel a bit clichéd saying it, but we are absolutely committed to the quality of what we do. We care about our clients and that makes us want to do the absolute best we can,” she says. “When we’re taking over failed care packages, and you speak to people about why these packages have failed, the lack of attention to detail comes up all the time. The lack of supervision of staff, the lack of support of staff, the lack of support of clients. “But with us, we do what we say. We say we offer a 24-hour on-call service to our staff and clients, and we do. We offer the clinical support as well. It isn’t just that the 24-hour service is for emergencies only, it’s there for whatever. If someone’s just a little bit worried that the client doesn’t look too well, it might just be a bit of help or advice they need, but we’re here for whatever it might be, anytime. “We also want to do everything we can, go above and beyond. If we can make something happen, we will. It might not be a straightforward process at all to take a client on holiday, for example, but life is for living. And if we have to take some little, measured risks to enable people to get the best out of their life, then we’ll assist in whatever way we can.” The team, throughout the business from director level down, takes a proactive approach
Ongoing growth
With clients currently covering the whole of the UK - from Cumbria to the Isle of Wight, and over into Northern Ireland - the PCS caseload continues to grow, meaning the business is always looking to add to its team. “I think our steady growth over the years is testament to what we do. We don’t necessarily go out looking for work now, it just comes naturally, which I also think speaks volumes,” says Jin. “We’re looking for new clinical case managers nationally, we’ve got a network right across the country so we’re always looking for the right people to help us support more clients. “We’re in a very good position and have a good reputation and that’s credit to our managers. Support workers, and of course our fantastic clients too. “We will keep doing what we are doing, supporting the clients we are very fortunate to work with, while also having the ability to support even more in achieving something so important in their lives - their independence.”
