I have experienced case management from a personal experience. My mother-in-law was hospitalized with a catastrophic stroke on the very day my oldest son was graduating from grade school. We were heart broken. Marianne was a very important part of our lives. She helped babysit for our boys when we were both at work and we were her only family in Milwaukee. I am a nurse and was working on the very unit that she was admitted to. Everyone in the family felt I was very qualified to decide what would be needed for Marianne when she would go either to home, rehab, or the nursing home. Even though I understand the health care system, I was devastated that my mother-in-law had a stroke. She was confused and anxious. She was so different than her "real" self. I kept hoping for a complete recovery all while knowing it wasn't going to happen. During this time health care was very overwhelming to my husband and myself. As her condition stabilized it was obvious she wouldn't be able to return home. The question now was could she go to a rehab unit or would she need to be in a nursing home. This was when our case manager was incredibly helpful. She arranged a rehab consult. We didn't know how to even begin with that. She was there when we were told Marianne was denied access because they felt her stroke was to severe and she wouldn't improve. Knowing that case manager knew us and our hopes, we believed she had done all that was possible and that Marianne wasn't an appropriate candidate for rehab. When the sad decision of nursing home placement was the last option we received help from our case manager. She helped narrow our search. She took into consideration our feelings, Marianne's strong faith, and our proximity to the facility. She arranged visits at three nursing homes after discussing the positive and negatives of each. We chose the nursing home and our case manager arranged the transfer of Marianne to The Lutheran Home. The transfer went smoothly and we truly felt supported. Our case manager gave us direction during one of the saddest times in our life. At that point in time I was a hurt and confused daughter-in-law, not a nurse.

Guest Patient Long-Tem Care Comments

Health care, where does one begin to solve the problems that are emerging as we speak. As stated in this blog, the number of patients needing long term care increases daily and will be on the rise for a very long time. As a nation devoted to taking care of the ageing, I believe we are taking steps backwards. The reforms proposed all make a lot of sense to me however they do require some additional spending and it seems to be very hard to get people to realize that change and betterment does not come free. I strongly agree that we need to require better training on the parts of the care givers. I find it hard to believe that you can spend one week and learn everything you need to know to care for an individual who needs medical care. As a health care patient myself, I would be very upset if my care giver was just someone who spent a few hours learning very little about caring for patients and administering medication. It seems to me that we are just trying to get by the cheapest way possible by replacing licensed nurses who have received years of training with someone who can be paid less, requires only hours of training, and will get the job done even if it might not be done in the best interest of the patient. As either patients now or future patients, I believe we need to take a stand and push for reforms like those stated in this blog. By doing this we must also look to our future. As stated in reform #2, we must ourselves take action on long term care insurance. We can not rely on the government to take care of us down the road. Long term care insurance needs to become a staple in our lives just like health, home and car insurance. Many will say that they just can't afford it but the truth is they can't afford not to have it. If the importance of this can be taught to all people early in life and more people start purchasing it, it should become more affordable and also something that people won't be without. As a cancer survivor, I received wonderful care from skilled doctors and nurses who I know were very well trained in what they were doing. I can't imagine what my experience would have been like had they have been people with very little training. As I get older I would like my future experience with health care to be the same as my past experience. Just because people get old or are near death should not mean that they are not as important and don't need wonderful experienced caregivers. We need to care for all ages or illnesses the same. No one life is more important than another. Quality care must become a requirement and reforms like those stated in this blog are just the start.

Guest Student Comment

Healthcare has been a very touchy subject in the last few years and is something that needs reform, especially when dealing with long term care for the elderly. This is a topic that severely needs to be addressed especially since the baby boomer generation is entering or only a few years away from needing long term care. I believe and agree with most of the arguments made in this blog and long term health care should be affordable, available for everyone who is in need, and an overall better quality of care is needed.

I think the most important issue right now is the issue talked about in the Reform Proposal #4, unskilled men and women providing “care” for the elderly. This is a huge problem and one place I think the government needs to step in and reform. Like it was said in the reform proposal, thousands of elderly adults are receiving inadequate care from untrained providers. I believe there is a line that has been crossed by many health care facilities because they are trying to save money. Hiring unskilled and uneducated (in the field of healthcare) men and women to give medications, look for signs and symptoms of the medication they administer, and provide other healthcare needs is just not acceptable. If I was in a long term healthcare facility I would want a trained RN to be watching my symptoms and not someone who was trained for 34 or even 85 hours (6 to 11 days on the job). I would want someone who went to school for years to learn about these medications and the symptoms that could result to be my healthcare provider. This type of treatment does lead to extra hospital visits, increased stress and pain, and a higher cost of long term care for the patients. Also the long term care provider can make a few extra dollars. This is just unacceptable in healthcare. The patients should always feel as they have the best healthcare provided to them as possible, which is not happening at the moment. The government needs to step in and make tougher requirements for these types of long term healthcare positions. Training needs to be increased for all workers and medication handout and all other healthcare provisions should be provided by a trained RN who knows what to look for and how to provide the best care possible.

I also believe that long term care should be offered by medical insurance plans and not only offered but become the norm. When a patient is planning for retirement, it should be in their retirement plan that long term care may be needed, this means purchasing long term care insurance. If this became a “normal” thing to do, long term care would be a better service because most of the money for the care would not be coming from government funded programs like Medicaid. I am a firm believer that government run healthcare is NOT a benefit for overall healthcare. Also, like stated in proposal 2, if purchasing long term healthcare insurance became something that all Americans did, the cost of that type of insurance, which is high now would decrease tremendously as well as provide more money to long term healthcare providers. This would be an overall win for everyone involved. The patients, although spending more, would receive much better care from the facilities, because the facilities would be making more because they would not be getting most of the money from Medicaid. Also, the government would be spending billions less, therefore reducing the national deficit.

I also agree with the fact that many TRAINED nurses do not have the working conditions and benefits needed to stay in this field. There are thousands of shortages because the working conditions and benefits are not what they are in other healthcare facilities. In order to keep trained nurses in this field, wages need to be increased; retirement and healthcare benefits need to be improved, and a better working environment must be provided. Also, these trained RN’s should not be let go so a “trained” CNA can be hired. Like stated in proposal 1, this could easily be done by the healthcare providers. If they increased the number of RN’s in their facilities they would decrease the long wearisome hours the current trained nurses have to work. Also, if they increased wages and benefits, more of these trained professionals would want to stay creating a happier environment for residents and the nursing staff. This extra spending could save the healthcare provider in the long run by decreasing recruitment and training expenses which costs billions of dollars a year.

One proposal that I did not completely agree with is that a hospital should be required to provide a case manager for each patient. Although this idea sounds good in practice I do not think it would work. I believe this because many of the patients in long term care already have doctors, nurses, and other care providers to deal with. Many of these patients want to live their life as best they can without assistance. Adding another person grilling them and talking about the care they need would not be beneficial. If a case manager is needed, it should be provided by the long term provider and go from hospital to hospital with the patient tracking the case. This case provider should also be extremely educated not only about the patient but also the care being provided which leads to the issues talked about earlier. Also, there is the problem with funding for a case manager. Hospitals do not have the time or resources to find and assign a case manager to every patient in long term care. Putting that responsibility on a hospital that sees the patient only a few times a year is not the answer. I also do not think the long term healthcare provider should provide a case manager but should do their best to provide the best healthcare possible and adding an extra thing like case management would decrease healthcare provision. I think the best way to fund a case manager is for the family of the patient or the patient to pay for their assistance. This way it removes all the issues of the patient not wanting a case manager and who should be providing this case manager.

Overall, I think this blog provided a lot of insight into the field of long term care. Providing this care for the elderly who fought for our country, inspired the youth, and provided for us while we were young is extremely important and should be top notch. Right now there are many issues in the field that need to be dealt with before the number of patients receiving this care increases dramatically. I think this blog is very educational as well as provides fixes for the many issues plaguing long term healthcare.

-Josh Kolz

I am studying Biomedical Engineering/Pre-med at UW-Madison. I plan to go into the field of cardiology or orthopedics. Both of these fields deal with heavily with patients who need or will need long term care in the near future.