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‘We could resume some normality but should we?’



In the latest in our series of Q&A features with case managers to assess the impact of the pandemic, here Louise Sheffield of Active Case Management shares her thoughts and experiences.

Can you summarise how the past few months have been for you.

This year has been a strange one! There was a swift acceleration from the virus starting to be on my radar to it being upon us. It was a whirlwind and we had to think very quickly, with very limited information to make sure that colleagues safety was maintained and clients were looked after.  

It sometimes felt like every day there was a shift in priority and the advice from the government was really fluid and difficult to process.  

It was overwhelming, but also (I’m embarrassed to say) a little exciting to be applying our skills to such a novel situation.  

It was good to settle into a new normal of working from home and we worked out efficient and effective ways of the team keeping in touch with each other. Then we could return to the office and client visits in summer which brought some normality, but with it came the responsibility of decision making. 

We could resume some normality but should we? 

In Case Management we think creatively, manage risk, make weighty decisions and solve problems. But never before have we done this so often and with so much at stake. 

How did you adapt to the restrictions of lockdown? Were you able to do this quickly or did it take a bit of time?

Prior to the first lockdown we separated clients into those who we believed to be the most vulnerable, i.e those who would be less able to recover if they contracted coronavirus. We decided to cease all face to face contact with these people immediately.
Beyond that, we stalled while trying to make sense of what was going on, especially as lockdown started.

However soon we developed a more sophisticated tool to score the risk profile of every client which helped to shape decision making. Keeping the clients informed was challenging because often they had questions which we couldn’t answer. 

As the weeks of lockdown continued, it became evident that the priority should not always be to minimise risk of contracting coronavirus;  for some clients, the lack of rehabilitation was causing real problems which took priority over avoiding the possibility of contracting coronavirus so we had to rethink. 

We are still rethinking and often we have gone through the process of digesting the newest guidelines, working out how this will impact on each client, communicating this to the client and their families, only for this to change a few days later.

What have been the main challenges – were you able to overcome them? 

Sorting out the tech has been a nightmare; it isn’t a strong point of mine and I’ve been on a steep learning curve but now I know what is what, I wonder what was I ever scared of!

Has the use of telerehab been of benefit to you? 

Yes, enormously.  It has enabled the team to stay in touch with each other and also with our clients, their families and those who instruct us. Initially we stuck to email and telephone but quite quickly we realised that the lockdown would last more than a couple of weeks and an alternative would be needed. Since then, our Zoom account has been ‘hammered’!

How have your clients responded? Was it difficult for them to adapt to?

Some clients took to it straight away, others needed some help and a few have not got along with Zoom at all and we have maintained contact through telephone calls.

Do you feel the lack of face-to-face contact with clients or/and colleagues has been damaging? 

I don’t believe that telerehab is a complete substitute for face to face contact, but it is a very good ‘second best’. 
However for some clients, their cognitive impairment meant that it was particularly challenging for them to access telerehab and their physical needs were such that face to face therapy was required. This meant careful negotiations with the treating therapists to work out the best way of the clients’ needs being met without compromising safety. 

I have been impressed by the resourcefulness and creativity of the therapists whom we have instructed and they have been able to adapt their approach, drawing on all resources available (such as willing family members or support workers) to deliver interventions which were as close to ‘hands on’ as possible. 

Occasionally there has been no alternative but to see the client face to face and each visit has been carefully considered and risk-managed. It hasn’t been easy, and still continues to present challenges but we are now more accustomed to the procedures which maximise safety.

How central do you think the use of telerehab will be for you going forward? 

I doubt that we will ever return to our former ways of working and I think that Case Management practice will change for the better as a result of learning during the lockdown periods and periods of lesser restrictions.  Physical attendance at MDT meetings is not necessary every time, and with good planning it is possible to have meetings which are shorter and more frequent to ensure that everyone on the team is kept up to date and email traffic is reduced. Speaking of traffic, I haven’t missed travelling to Manchester so often and the inevitable queues on the M60!

How do you think the future of case management has been shaped by the pandemic? 

Our resourcefulness, flexibility and proactive risk management have always been strengths in our profession and these have been tested and developed further. We have also been pushed out of our comfort zone, which has been positive. Telerehab is now one of the tools which we will use routinely to bring teams together around our clients.

Will you be doing anything differently within your business going forward compared to pre-pandemic? 

Our thinking around the importance of office space has changed, which will inevitably mean a shift in budgetary allocation towards enhanced technology and away from physical environments.

We have recently undertaken a significant recruitment drive using Zoom for the interviews, which I would never have considered a year ago but it has been really successful.