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Delivering the right support at the right time

How ILS Case Management intervention enabled Ellen to look to the future after a distressing COVID lockdown

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Having the right support in place is vital to help people overcome challenges in their lives.

Here, case manager Odile from ILS Case Management shares the story of her client Ellen, and how the intervention of the ILS team has helped her to live her life again after the impact of COVID-19 lockdown

Meet Ellen

It is a joy to work with Ellen. She is a kind thoughtful woman, who has a fun sense of humour, loves to laugh and be sociable with family and support workers.

Ellen lives with a learning difficulty, has minimal verbal communication and uses a tilt in space wheelchair. Ellen can use behavioural outbursts to express herself if she feels her needs, wants or wishes are not being met.

She lives in supported community living, and currently there is only Ellen and one other resident in the home. She has privately purchased her manual and powered wheelchair and has a wheelchair accessible vehicle. 

Ellen’s family are very supportive, and Ellen has daily contact with them via Skype. While she would love to see more of her mother, she lives around an hour’s journey away but does not drive, so tends to visit when Ellen’s ILS support worker, managed by me as her case manager, is on shift and can drive Ellen’s car. 

ILS case manager Odile

The local authority provides her package of care, which includes daily one-to-one care and overnight sleep-in care via a care agency. Ellen’s Deputy finances a top-up to this service to provide 24-hour care. 

In addition, Ellen has a support worker she directly employs via ILS to work two 7.5 hour shifts a week. This role delivers quality of life enhancement for Ellen through the enjoyment of activities the main care provider finds difficult to offer. It is, if you like, the ‘cherry on the cake’ care, enabling Ellen to participate in activities that many of us might take for granted such as outings to places of interest and seeing family. 

The damaging impact of lockdown

During the pandemic and lockdowns, Ellen became very isolated. 

The care agency became very controlling and there was minimal communication from them to either the family or me. The agency were the only people allowed to see her during that period. 

Ellen’s behaviour deteriorated and she refused personal care and lost weight. The care agency did not highlight this to social care or me, and it was not until the agency finally allowed the ILS support worker to visit that these issues became known. 

Safeguarding became involved and the care agency agreed to work more openly with the external support. 

Over time, the care agency reluctantly allowed the reintroduction of the ILS support worker, who now takes Ellen out and assists the care agency to positively support Ellen in everyday living using behavioural tools. 

Ellen’s tone had increased, and she complains of pain in her shoulder.

ILS Case Management intervention on Ellen’s behalf

The care agency did not want physiotherapy going into the home. I worked extremely hard to impress upon the agency that Ellen needs to receive physiotherapy to manage her tone, and liaison with social services occurred to help support the agency to allow therapy to resume.

The physiotherapy massage has now been reintroduced weekly. This is enabling Ellen to reduce her tone and for the therapist to share techniques with the care agency to help reduce tone every day. 

I referred to speech and language therapy to review her diet and monitor her weight. The therapist has now visited and advised on diet and set up bi-weekly weighs to monitor Ellen’s weight.

I am working with the care agency to support Ellen in using her powered wheelchair, so that she can go for longer walks with her ILS support worker and family. 

It is taking time for Ellen to build up her outings again with her ILS support worker and, although this process is in the early stages, it is going well. 

With the additional support now in place, Ellen is starting to respond well to socialising and trying new activities as well as revisiting old activities she used to enjoy. 

Ellen’s family would like her to be placed closer to her mum and to be provided with more consistent and higher-level care as the family do not feel this is currently provided by the local authority. 

Her ILS support worker has taken on some of the main carer roles such as taking Ellen for her optician visit, as the main provider has not been able to manage this. When viewing alternative accommodation that is identified to assess its suitability, additional support will also be required to ensure the right placement is found for Ellen.

The ILS support worker is also looking into groups locally that Ellen may be able to safely attend, to enable her to have more social interaction with people other than her support workers and family. 

Ellen has access to her iPad that allows her to communicate virtually with her mum and other family members and Ellen’s ILS support worker sets up FaceTime with Ellen’s grandmother. 

She has expressed an interest in going swimming and has revisited the local hydrotherapy pool with myself and her ILS support worker. 

The benefit of the right support

There are many aspects of Ellen’s life that needed and continue to need case management attention. 

Working with a care agency that does not engage with external support has proven difficult. As the pandemic and lockdown came into force the loss of weekly activities and contact impacted heavily on Ellen. 

The care agency did not allow Ellen to have any visitors or go out at all due to the pandemic. It took a lot of time and patience to be able to get external support services back into the home. 

A fast turnover of agency staff led to a lack of training, and this led to some negative responses to Ellen’s support needs such as telling family Ellen is having a ‘No to anything day today’ and ‘down time from 9pm means no contact with family’. This upset Ellen’s family. 

Working closely with the family to support them in communicating with the care agency has been particularly important and prompting the care agency to contact the family regularly is ongoing. I have found working closely with the Deputy team especially useful and extremely supportive, and this will naturally continue.

In addition, having the ILS support worker who is open to learning, and who I have been able to train and support with communication and behaviour techniques, has been a vital lifeline for Ellen. It also means that I can make sure she is monitored, and if any issues arise, I can flag them with the local authority.

Now lockdown is behind us and as we move forward, it will be vital that the care agency have continued external support and that I and Ellen’s ILS support worker maintain a positive working relationship with them. This will ensure that we can provide them with the support and training required to maintain the focus on Ellen’s best interests and quality of life. 

Case management

Deadline tomorrow for CMSUK Awards entries

Nominations can be received until the end of Friday

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Only 24 hours remain for nominations for this year’s CMSUK Awards. 

The CMSUK Awards 2022 this year focus on recognising innovation by those working in case management in the ever-changing world, and commitment to clients. 

The awards have received a strong response from case managers and those working in associated sectors, but any last-minute entries can still be made ahead of tomorrow’s deadline. 

Categories open for entry are:

The theme of ‘Overcoming challenges in an ever-evolving world’ has been chosen to recognise the turbulent times in which we live and work, and how the dedication of case managers and other professionals to achieving the best outcomes for clients only increases in the face of that.

Having been a virtual occasion last year due to the ongoing restrictions of COVID-19, with a reduced number of categories open for submission, the awards return to an in-person celebration event in London.

The deadline for entries comes ahead of the judging process, announcement of the finalists, and winners being named at the celebration lunch on September 23. 

“It is fantastic to see how case managers are using innovation and reflection to maximise outcomes for clients in this ever-evolving landscape,” says Niccola Irwin, director of CMSUK. 

“The world is changing all the time, with challenges constantly arising in addition to everything we have been through over the past two years, and case managers are doing some great work in helping clients through this. 

“Having had a very pared back awards last year, we are now able to return to being able to give recognition in more areas – for example, we realise that catastrophic work is very different with its own challenges, so we have the opportunity to acknowledge that. 

“We also have the external and internal awards, as well as the partnership award, which are able to showcase a portfolio of work and demonstrate multi-agency input, which can be hugely effective. 

“We also have the large and small case management company awards, which again acknowledges that both companies work in very different ways, with different practices and approaches. We are very pleased to be able to recognise this again. 

“We are looking forward to being back together in-person at what promises to be a lovely afternoon and hope to see many of our colleagues there.”

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Insight

Should I stay or should I go?

ILS Case Management looks at supporting the whole family when a young person with brain injury leaves home

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Case manager Jessica Heather looks at how ILS Case Management and the MDT gave Martin the confidence to fly the nest and his family the reassurance to let him go

 

As a case manager working in the world of personal catastrophic injury, I never know what a case is going to involve. Each case is as individual as each client – some of their needs may be similar, but the complex picture is unique.  

The nest, and a family changed

Martin sustained a traumatic brain injury (TBI) as a passenger in a car which collided with a telegraph pole. He was in his early 20s at the time of the injury, and when the case manager was introduced, he was only a few months post injury.  

Martin was living with his parents, Sarah and David, as he had been at the time of the injury. He was the youngest of three boys and the only one still living at home – Sarah was in no rush for her baby to fly the nest. 

Jessica Heather

David was working in the transport industry with shift patterns that meant he was often either working or asleep, therefore it was Sarah who was the main support for Martin – whilst juggling her part time role in a care home – although she was on compassionate leave at the start of my involvement. 

Martin was experiencing difficulties with motivation, memory executive functioning, anger management and reduced physical abilities. 

He was bored, despondent, and often quite rude to his family. He had no purpose in life and tended to drink too much and was thought to have been dabbling in recreational drug use, although this was never proven. 

Taking practical steps

The first role for me as case manager was to carry out a detailed assessment and identify what input Martin needed. I then progressed to build a team of skilled professionals to work with Martin to understand his difficulties, gain some insight, and increase his participation in everyday life. 

I recruited an occupational therapist (OT), shortly followed by a neuropsychologist and a physiotherapist.  I used my skills gained from many years working as an OT and then a case manager to identify the impact that the situation was having on family dynamics and initially, I spent time supporting Sarah, as well as Martin. 

During the first year, the team carried out assessments, both standardised and functional. 

I recruited a rehab assistant (RA) to support Martin to develop more routine and structure to his week and to supplement the therapy intervention. Martin started to volunteer in the grounds of a local stately home and the RA would support and feedback to the team. 

Martin was desperate to find paid employment and having concluded that garden work was not for him, he volunteered in a local charity shop, where he was loved by the older volunteers – ultimately, he landed his “dream job” working in clothing retail. 

It was important for Martin to obtain the job without them knowing the details of his injury, but following on from this, he consented to the OT meeting with his manager to give him some informal training as to the difficulties that Martin might encounter and how best his manager could support him if needed. 

After approximately a year of MDT working (OT, physio and neuropsychologist, coordinated by the case manager) the team had reached the situation where Martin was becoming difficult to engage in some aspects of rehab, saying there was no point in doing certain things (e.g. cooking, budgeting, shopping) as his mum did it, but the team were concerned that he’d struggle to do these things when he moved out of the family home – whilst holding down a job. 

In essence, the team felt that his true difficulties were being masked by the support he had around him, which impacted on his ability to gain insight into his difficulties.  

I recall a meeting with the solicitor where I found myself saying the words “independent living trial” (ILT) before I could stop myself. I wasn’t sure what it would involve, but it felt that it was what was needed in this case. The solicitor and team agreed, and I later met with the occupational therapist and neuropsychologist to work out more details. 

We spent a couple of hours brainstorming what we would want from and ILT, how it might work, who would need to be involved, what would be needed to enable it to happen and we came away with the outline of a plan. 

I then spent time putting the detail to the plan. Time scales, level of support, costs, frequency of therapy visits, outcome measures and how we would know what we wanted to know – whether Martin could live independently, or not. I shared this with the solicitor and funding was agreed. 

The best laid plans

Like so many things, the plan needed to be tweaked. It took months to find a suitable rental property. I asked the OT to take the lead on this, as a cognitive exercise for Martin – an example of ongoing assessment. It took multiple viewings and much compromise to find a suitable property.  

By the time the right flat had been identified, the treating OT was on sick leave for long-awaited surgery, the client was in a new relationship, and we needed to set boundaries around her input, so we weren’t getting a false picture of Martin’s abilities.  

Regardless, I drew on my skills to problem solve. I recruited a new OT and found a rehabilitation assistant to be the team’s eyes and ears. The MDT devised feedback forms for those around Martin so the team could paint the full picture of what support, formal or informal, he was receiving. 

I agreed ground rules with Martin, and gave his partner Pippa and Martin’s family some training as to what we were trying to achieve and introduced the feedback forms. 

Following extensive liaison with the litigation team regarding finances, guarantors, furniture acquisition and moving costs, and the ongoing negotiations with the estate agents, Martin moved into his flat and finally the ILT was launched.

Meanwhile Sarah had grown increasingly anxious about Martin leaving home, and I decided to source support for her from a clinical psychologist, separate from Martin’s therapy team, to address her emotions regarding the trauma of the initial injury, adjustment to the person that Martin had now become and her concerns regarding her youngest, more vulnerable son, leaving home.

Able to fly

Martin was brilliant – he excelled in his new home thanks to all the careful preparation that we’d put in place. 

He used OT strategies and kept the flat clean and tidy, he didn’t have all his mates over drinking, as had been one of the many concerns, and the team were able to scale down their input more and more as time progressed. 

The bird’s eye view

Martin, his partner and family completed feedback forms, and the RA fulfilled their role as the eyes and ears of the team to enable a comprehensive picture to be painted of how Martin was managing – living independently. 

The feedback forms were critical, so that the team could identify what Martin was completing independently and what, if any, support he was getting from those around him. 

Was his Mum giving him extra money, or cooking for him every night? Was he on the phone to her all the time for reassurance? Was his partner actually doing the cleaning and not him? 

We made it clear that we didn’t want to stop support, it was his first time living away from home, but that we needed to know it was happening so we could gauge how dependent he was on that support and what formal support might need to be kept in place longer term. 

Six months passed and many of the fears that the team, the solicitor and his parents had experienced, were not borne out and Martin himself was delighted with his achievements.  

The ILT had served its purpose, given him insight into what strategies he needed, such as a weekly planner, meal planning and shopping tools, and a reminder for household chores such as cleaning and putting the bins out. His family, in particular his mum, were reassured that he could manage independently and the team had scaled back the support to the bare minimum. 

Flying – but now back home

At the end of the six months trial, the client and the family were confident in his abilities. He opted to move back home (and his partner moved in) so they could save for their own property. 

Flown the nest

Eighteen months after the ILT, at a case management review, Martin was living in his own home with his partner, working, and still using some of the strategies learned during rehabilitation. He invited his parents over for lunch on a regular basis and was looking forward to starting a family.  

I clearly recall the sense of satisfaction driving away from that review visit. 

It has been quite an uncomfortable visit – for all the right reasons. It felt intrusive. Martin was no longer that lost, vulnerable, angry young man. He was living with his partner in their own home, he was working, he was contributing to running the household with his partner and they were planning to start a family. 

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Case management

One week left for CMSUK Awards nominations

Case managers and those in supporting sectors still have time to make their submissions

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Case managers have a week left to submit nominations for the CMSUK Awards 2022, which this year focus on recognising innovation and commitment to clients in the ever-changing world.

The awards have already received strong levels of entries, but with the closing date set at next Friday – June 24 – there are only a few days remaining for any last-minute submissions. 

Categories open for entry are:

The theme of ‘Overcoming challenges in an ever-evolving world’ has been chosen to recognise the turbulent times in which we live and work, and how the dedication of case managers and other professionals to achieving the best outcomes for clients only increases.

The awards are open to case managers and those working in supporting sectors whose work contributes to delivering the best outcomes for clients. 

Having been a virtual occasion last year due to the ongoing restrictions of COVID-19, with a reduced number of categories open for submission, the awards return to an in-person celebration event in London with nine accolades to be won.

The deadline for entries comes ahead of the judging process, announcement of the finalists, and winners being named at the celebration lunch on September 23. 

“It is fantastic to see how case managers are using innovation and reflection to maximise outcomes for clients in this ever-evolving landscape,” says Niccola Irwin, director of CMSUK. 

“The world is changing all the time, with challenges constantly arising in addition to everything we have been through over the past two years, and case managers are doing some great work in helping clients through this. 

“Having had a very pared back awards last year, we are now able to return to being able to give recognition in more areas – for example, we realise that catastrophic work is very different with its own challenges, so we have the opportunity to acknowledge that. 

“We also have the external and internal awards, as well as the partnership award, which are able to showcase a portfolio of work and demonstrate multi-agency input, which can be hugely effective. 

“We also have the large and small case management company awards, which again acknowledges that both companies work in very different ways, with different practices and approaches. We are very pleased to be able to recognise this again. 

“We are looking forward to being back together in-person at what promises to be a lovely afternoon and hope to see many of our colleagues there.”

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