Case Management: The "Caring" Profession


I.               Introduction:  A pundit…. Has anyone seen a pundit?

                  I suppose I should begin by asserting to those who may read these words, that I, in no way, consider myself to be an ‘expert’ on the subject of Case Management. I am merely one who has spent the lion’s share of my time in Human Services doing various forms of Case Management, and the words that follow are only my thoughts and opinions based upon my work experience. If you want to get the final word on any of these subjective ramblings, then I would advise that you find a pundit. You know… someone who has spent most of their career in the higher echelons, someone who may have done research, or written a book, etc. I’m sure that they are out there… somewhere…

II.              The ‘Eveready Bunny’ of the helping professions.

                  Consider the wordy, run-on title of this discourse – Case Management has always struck me as being the ‘service engine’ that drives many organizations, some of which you may have interfaced with in the past - those which perform various residential, educational, vocational, recreational, legal, medical, etc., functions. Some examples of Case Management positions within which I’ve endeavored over the years are Protection and Advocacy, Family and Children, Medicaid Waiver, and Vocational Counseling. A Case Manager is someone on the front lines who manages the cases of the clients that the organization serves, the one who makes sure things get done in as timely a manner as possible. Anyone reading this who has never heard of any of these terms or functions, has probably died of boredom by now, that is, if they are still reading.

III.            Do what I say… not what I do…

For those of you who are still reading, and are not dead, I am heading toward a point here, believe it or not. A social service organization, like any other goal-driven endeavor, is characterized by a chain of command. In simple words I suppose that you could boil it down to those who are supervised and those who supervise. Of my thirty years in the profession, I have been a supervisor for only something over two years. I have mostly been a ‘supervisee’, and I guess it has only been in the past five or more years that I have finally come to terms with that fact. It used to feel vaguely like a failure on my part to have been predominantly on the ‘peon’ side of the equation for all of these years, but that was because I had taken my eyes off the ball, so to speak… I had forgotten what was really important. What is really important is that the mission of an organization, presumably to serve those in some kind of need, is fulfilled. The ghost of my ‘Type A Personality’ father was often just over my shoulder, asking me why I wasn’t running the world by now. I woke up one day feeling confident, however, that I have used my energy and talents to the best of my ability in service to my fellow man, and have concluded that that should be the barometer of my success. But I digress… Let’s see… I was heading toward a point… Oh yes! Case Management! 

IV.            My two cents…

                  My take on Case Management is that for it to be healthy, there has to be a balance between the administrative part of the job, and what might be referred to as the ‘counseling’ part, the part that involves interpersonal interaction with one’s clients, whoever they may be. I wouldn’t exactly posit that it should be 50 – 50,  or anything in particular, because these percentages would probably vary, depending upon various circumstances such as the nature of the specific mission of the organization, the rules and regulations on a federal, state, or local level that the agency must adhere to, and another  factor that might very well be the biggest enchilada of them all – the ebbs and flows of government funding! It’s a feast or famine world out there, folks!

                  Back in the ‘90s, it seemed that organizations had far better staffing levels than they do now, and far more reasonable caseload sizes than they do now. A ‘Caseload’, for those of you who aren’t familiar, is essentially the amount of clients that any one Case Manager has to serve. The ‘90s was an era in which the economy was doing well, compared to now, and governments had more money to target toward problems that existed. Well, the same problems exist now, but the economy isn’t what it used to be, and there isn’t the abundance of tax revenue to throw around. As a result, staffing levels are smaller, and caseloads are bigger. More work is piled on the backs of fewer people. I have always found it interesting, but rather alarming, how standards morph, depending on whether we are in a period of feast or famine. It used to be with my current occupation that a caseload of no more than 75 was considered appropriate. Now, twice that amount or more is somehow deemed to be appropriate. Indeed, there were some Medicaid Caseworkers that had Caseloads approaching 1000! All of this translates into less quality time with clients, and more time encumbered with paper work. You add to that the rapid technological evolution of the past 20 years, which has led to the predominance of computer technology, the resultant advent of constant change, and the turnover of government administrations, and you have an ongoing ‘three ring circus’ going on, in which our health deteriorates as we spend more and more time in front of computer screens, bludgeoned with change.

V.             Walking into the sunset…

Constant change… continuous reinvention. Job stress. I sometimes joke that my brain feels like a concrete wall in a racquetball court. My grey matter simply cannot absorb any more new information!  I’ve given up on the idea of reaching a time when my job will stabilize, and I won’t have to learn it again every year or two. But, in the words of one of my favorite contemporary musicians, Mark Knopfler, “that’s what it is”. For better or worse, that’s what it is. We do the best we can, despite the changing circumstances we are faced with. All of which leads me to look forward, with anticipation, longing, and outright exuberance, to the time when I can retire, the time of quiet when, in the words of Paul Simon, another of my favorites, I can “release my fists at last…”