Fostering hope improves outcomes, reduces costs
Add this four-letter word to your vocabulary
Fostering hope may not be part of your regular case management plan. Yet if you work with clients who face devastating disabilities, giving them hope may be the most important thing you do to improve outcomes and reduce costs, says Nora Palmer Fox, RN, CCM, president of Case Development in Englewood, CO.
Her personal struggles while raising one severely retarded son and handling the spinal cord injury of another lead Fox to question how her own hope or the absence of it affected herself and her children. "I looked at how hope and lack of hope had affected us through the years and began to wonder how case managers might impact their clients if they learned the importance of hope and how to foster it in their clients," she says.
She sent out a 15-question survey through the Internet and received 103 replies from across the country and several from abroad. Survey questions included:
• Please relate any stories, events, or anecdotes that dashed your hopes.
• What affect did that have on you, your family, or your daily life?
• Please relate any stories, events, or anecdotes that gave you hope.
• What affect did "giving of hope" have on you, your family, or your daily life?
• Has a belief in a higher spiritual power helped you? If so, please explain.
• Is there any one thing that sustains you in your worst moments?
• If I can relay just one message to case managers, what do you think that should be?
Some of the responses were four or five pages long, Fox says. "Reading the responses not only touched me deeply, but gave me hope that, as a case manager, I can make a positive difference."
Where is hope found?
Survey respondents identified many areas of daily life in which case managers can help foster hope, Fox says. Those areas include:
• technology;
• employment and future plans;
• finances, wills, and trusts;
• insurance companies, agencies, and services;
• medical providers and therapies;
• education;
• recreation and leisure;
• religion;
• family and community.
"By listening actively to your clients and their families, you can do much to foster hope and improve outcomes simply by identifying areas in which they need support and linking them up with services or providing them with information," she says. "When hope is not fostered, a downward cycle begins that can lead to increased costs, negative outcomes, and the need for more resources."
Fostering hope may not be a comfortable concept, but it’s much easier than you may think, Fox says. She asks case managers to consider the following example:
You are working with a mother whose daughter has multiple disabilities. Her pediatrician offers no hope for her daughter’s progress. The mother asks him for the name of support groups where she can meet parents in similar situations. He refers her to her primary care provider. She becomes increasingly isolated and depressed.
The mother seeks support from a homeopath, whose services are not covered by her health plan. She reports that the homeopath took the time to get a complete history of her daughter and herself, stressed the positive aspects of her daughter’s condition, and enabled her to accept her daughter and enjoy her more as a person.
As a case manager, you could handle this situation a different way. You could refer the patient to a more supportive pediatrician. Or talk to her current pediatrician and attempt to change his approach. You also could find the names of support groups for the mother or suggest several Internet support groups, if it is difficult for her to leave the house. You could do some research, find her a good alternative provider, and discuss the use of alternative providers with the current pediatrician and the health plan.
"By simply listening actively to the mother’s needs, you can become part of the solution and end the downward cycle," Fox explains. "If you also provide the mother with knowledge and information about the child’s condition in a kind and positive manner, you empower the mother to take steps to assist her child and family."
Fox says failing to foster hope has numerous hidden costs. "Without support, the mother may become more isolated and depressed. She may need therapy or meds, adding to the payer’s costs. We have to learn to accept our clients for where they are physically and emotionally and foster a cycle of hope that has actual, measurable outcomes."
Using the same client described above, here are some outcomes Fox suggests you measure to test her theory that fostering hope decreases medical costs and improves outcomes:
• Is the mother using fewer office visits and psychiatric services?
• Has the child’s progress improved since the mother’s depression lessened?
• Did the mother use the information you provided to help herself and her family?
• Is the mother functioning more normally and requesting fewer support services?
Building your argument
The answers to the above questions may even help you convince the health plan to pay for the alternative provider and ease the family’s financial burden, Fox says. Here’s how Fox suggests you present the case:
• Ask the current provider to document the child’s improved progress and to speculate what would happen to the mother and child if the current care ceased.
• Do a cost analysis comparing past care with current care.
• Include in your cost analysis that the mother is now functioning better. Add the potential costs of psychiatric treatments for the mother and increased hospitalizations for the child, if the mother’s depression leads to the disintegration of the family. "If the mother becomes clinically depressed, the health plan will pay," Fox notes.
"We are case managers in a changing and sometimes frightening world," she says. "If we foster hope in our clients, we will not save the world. We will improve their lives, and receive the hope and fortitude from their success to face each new day."
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