Case Managers
Case managers are professionally qualified people who oversee a team of therapists. They are not qualified as case managers as there is no professional qualification yet, but they must be registered with their own professional body such as NMC. Ideally, they should be affiliated with a professional body such as IRCM (Institute of Registered Case Managers) as they are trying to professionalise case managers and block unscrupulous people. I have discussed the more formal role of case managers in my Interim section. I will only concentrate on birth injured children.
In these blogs I discuss in a more personal way how CMs can enhance or detract from our lives and have collaborated with parents to gain other views.
I have heard real horror stories of CMs charging for a ‘dedicated printer’ for use with one child, and of kitting out their office with equipment charged to the child’s deputy. Case management can be very intrusive and you may feel you are losing control of your child as multiple professionals suddenly start doing all the jobs you’ve always done. Alternatively, it may be a huge relief to have someone take over some tasks, point you in the direction of equipment and therapies you hadn’t considered and lighten the load. Some families have had several CMs because they have had poor experiences and poor service. Hopefully I can give you some pointers on what to avoid.
Most CM have their own business and have a team of professionals like physiotherapist, Occupation therapists, AAC technicians etc. However, you choose the CM you want to work with. Just ensure you carefully research them and look at any reviews. Asking on support networking groups will also get good recommendations. We were sent a CV of a nurse CM with expertise in learning disabilities. This left us all scratching our heads as the kid has everything except a LD. Our solicitor sent us several, we interviewed them and chose someone who seemed the correct fit (good decision as it turned out). We also looked at our own circle of colleagues as we are in the NHS bubble and able to get some good recommendations.
Case Management in Interim
I’ve explained in my Interim Section how you must prove costs to the court/mediator to ensure the money is set aside for the child’s lifetime. So in Interim a case manager is vital as they are adept at seeing a need and looking at the best option as opposed to the ‘it will do’ option. So a beautifully fitted wheelchair as opposed to one which has dodgy suspension and won’t be comfortable is one they will source. They will arrange the best private fitting and the highest spec to suit the child’s needs. Our new wheelchair has the kid sitting beautifully as opposed to the NHS one (which to be fair is a good chair) in which he slumps and slides forward. NHS AFOs were rigid and painful. The private ones have silicone inserts in the pressure areas and are wearable. Well fitted equipment is light and day with some children, especially the awkward wonky ones! If they suggest something you don’t think is applicable now, rethink because they are people who have seen how disabled children develop into disabled adults, and know what may be needed. If the Defence aren’t made aware of a need, they will not set money aside for that need.
The case manager can also find a counsellor for you if you are finding coping difficult. Even if you don’t have your own personal case, the defence usually accepts psychological injury and will pay for it although it’s not guaranteed. They will also look at what statutory services you are entitled to and push for that if required.
The services they provide generate evidence to support the figures in the schedule of loss, thus maximising the compensation agreed at settlement.
Case Managers Post Settlement
You don’t have to have a case manager post settlement as your child’s needs have been established and money set aside for these needs. However, if the needs are high and carers are employed, the management of these services can be complicated (tax, NI, training, and payroll etc). The case manager’s fee has been calculated and allowed for if used during Interim. If you don’t use one this money accumulates, possibly for a time when they are needed. If you choose to do all the case management you will not be paid the formal fee of a case manager, but you will be paid for the time spent doing this managing. The paperwork needs to be submitted to the Deputy’s office for payment.
So, post settlement you have the option more to pick and mix your services. Working with the case manager to see where savings can be made, such as organising your own holiday, must be a natural thing and not seen by them as you encroaching on their territory. You are all working in the best interest of the child. Carers you may be able to supply yourself from a friendship group/personal recommendation should be incorporated into the CMs team, training, insurance etc given. Its much cheaper than outsourcing to a care company. When you look at the financial breakdown you must be supplied with, you may find ways to do certain jobs yourself, and reduce costs. A careful balancing act will have you able to manage certain areas and feel less sidelined, but also have someone do the heavy lifting.
With a hybrid system you can do a lot of the research, which is time consuming, to cut costs. You can do as much or as little as you want. An example would be researching hoisting for a hot tub. If you do all the measurements, work out what you want, google all available hoists that fit the bill and contact the suppliers about work costs, get reps out to survey the job then print everything out as evidence, you can just present this to the case manager and they can then action the purchase. They may have someone they can get a discount from, but they should not bill your child for the work you have done. If they do, question this! If you are too busy you can let them do all the research. It’s up to you.
Your Case Manager should…
- Answer emails promptly and answer any queries you may have
- Have 2/3 monthly MDT meetings (Zoom is cheaper) to update you on how your child is benefitting from the team members.
- Inform you if they are away and give you a contact number
- Listen to your opinion on what your child needs and find ways to facilitate them
- Meet your child early on and interact with empathy and respect.
- Set achievable goals which you agree with.
- Build a good team around your child with competent expert therapists.
- Treat you with respect and not as an annoying addon. You are not ‘my clients mother/father’ you are Ms/Mr …. until you can be on first name terms.
- The relationship must be built on trust and this trust is built using good communication, respect for you and your circumstances and their expertise.
- Post settlement they should understand resources are finite and not waste money, for example ‘copying in’ unnecessary people into emails as everyone charges simply to read them. Challenge this.
- Be transparent with costs. If you see areas where costs can be cut post settlement, your CM must do as you ask. A CM costs approximately £1 million over the child’s lifetime so make sure they cooperate with you.
The link between the CM and the Deputy is important as their needs to be trust that the therapy and equipment has been researched and necessary, then the money will be released to pay for the care. An unresponsive deputy or case manage just causes delay for your child.
Remember, the onus is on them to provide a good service and they must prove to you they are doing the best for your child in conjunction with you. You can change them or the therapist they employ if you are not happy. We’re probably nice compliant people who don’t shout and make demands, but we have learned to speak up, advocate and demand better as we’ve had no choice if our child’s needs are to be met. So, vote with your feet.
Costs
Schedule of Costs for Case Management Services
- Case Management is charged at £112.50 per hour
- Assistant Case manager is charged at £75 per hour
- Administration Tasks are charged at £60 per hour
- Travel Time is charged at £60 per hour (CM) and £40 (ACM) Mileage is charged at 55 pence per mile
- Insurance
These costs vary between companies and geographical areas.
Disclaimer. I’ve looked at the most common issues with Case Managers, but all children and cases are different so some issues may not be applicable.
