Case Management
Franchising - an exciting new initiative in case management
Richard Thorp, managing director of Circle Case Management, discusses how they are offering others a sector-leading route into starting their own business.
Along with my partners, Pippa Bird and Yvonne Spijkerman, two of the most highly respected case managers within the industry, we have owned and managed a case management company for nearly ten years.
Managing a mixture of employed case managers and freelance associates, alongside our expert witness and Mental Capacity Assessment services. Case managers often enter the industry without any experience.
With most case managers transferring from clinical settings, Circle Case Management provide training and high levels of admin, clinical and supervisory support, whilst working to create manageable significant caseloads.
We pride ourselves on our case manager retention, with many case managers developing their skills and moving into supervisory and service lead positions. We understand that as clinicians grow, they may want the opportunity to start their own business, as we did, making their own mark within the industry.
Case management is a personal service; case managers develop a close working relationship with a client (P) and their family, we understand that reallocating a case to a different case manager may not be the best option for P.
Disruption to P can have an impact on their recovery and wellbeing and with this in mind, we have created a new route for case managers that would overcome this issue and still give them the pathway to becoming a business owner.
The progression from clinician to business owner can seem like a scary jump to make, especially if the case manager has no business experience. The management of all aspects of case management, business procedures and clinical policies can be a lot for many to manage efficiently, especially with the advent of CQC registration and the growing requirements of instructing solicitors and Insurance companies making sole practice increasingly more demanding.
Knowing what decisions to make in the best interests of your business can be difficult when starting a new company.
Without experience and a deep understanding of the case management and the medio legal industries, costly mistakes can happen with processes which effects the level of service delivered to P. As an established business, we are able to reflect on case managers that have previously left our team to create their own businesses and ask “How can we assist case managers to reach their goals whilst retaining assets within the team that we have invested in?”
As a supportive management team, we wanted to provide another option for case managers to flourish with their own business, whilst also protecting the training, supervision, guidance and support we have invested into the case managers’ progression.
The Circle Case Management Franchise opportunity was the perfect solution - an innovative option that is not available with any other case management service provider across the UK.
Using our many years of business and industry experience alongside our outstanding reputation from our multi-award-winning teams of professionals, Circle Case Management enables ambitious case managers to buy a territory within the UK under the recognised Circle Case Management brand and create their own successful case management business.
We have created a unique launch assist program that will guide case managers into managing their own successful Circle franchise. The program is a full support system for your launch, including business registration, how to market and promote your business, and the clinical procedures and processes to ensure your franchise is a success.
We are launching our first three franchises into the world of small business ownership this autumn, with the support continuing throughout your Circle franchise journey.
Following launch, we will be holding regular business master classes to bring your company to the next level, meetings with our award-winning marketing manager to propel your business, mentoring owners to achieve CGC registered manager status to offer instructors confidence in your company; and helping these ambitious individuals through the maze of taking on their own clerical, clinical teams and associates with the full support of our highly experienced HR team.
Our franchise opportunity will empower case managers to be able to take the leap into business ownership, paired with our experience, they can drive their company forward to the heights of award-winning case management services.
There could be a franchise popping up in your area - watch this space!
To find out more, please visit www.circlecasemanagement.com.
Supporting parents of children with complex care needs
For parents of children with disabilities and complex care needs, life can be extremely challenging. Here, Michelle Marshall, case manager at ILS Case Management, discusses options around care and support, including home care and hospice respite
In a previous role, I worked for over ten years at my local children’s hospice as a children’s palliative care nurse. A large proportion of my work was organising, delivering, and managing the short break care which happened either at the hospice or in the community depending on the family and their preference.
Respite for parents whose children have complex care needs can mean many different things. For some it allows parents to go back to work, and others use the time to complete household chores, catch up on sleep or spend time with their other kids doing activities that they would not normally be able to do as a whole family.
Deciding to have respite care for a complex need’s child is a decision not often taken easily by parents. I have met many families who have put off having respite care for many years for a variety of reasons they may feeling that they are failing in their parental role and feel that they should be the person that their child relies on, they may not trust others to look after their child or be concerned that their child will not know the care givers.
So, what can help parents to make this tricky decision?
Sometimes it can be hearing about the experience of other parents whose children have complex care needs and have care in place already. Speaking to someone who is going through the process and can tell a parent how they find it, can be extremely powerful and influential.
Fast forward through those years without respite to the time when they begin having respite and parents will often reflect and think ‘why didn’t we do this earlier?’. Having the flexibility and choice of where to have the respite is usually the next big decision to be made by the family.
All families have diverse needs, preferences and circumstances which will influence their decision and sometimes the reality of that decision can be quite different compared to initial thoughts, once the care is in place. I’ll use an example of a family I have previously worked with.
The mother was due to have a care package introduced at home to enable her to have a break from her caring role and she was excited about this starting. A few months after the care package started, we discussed how this was going, and although there were no problems or concerns with the running of the package and the care being delivered to her son, the mother was struggling.
Having carers in her own home for long period of time meant that she was finding it difficult to relax and distance herself from her son and the carers. In addition, her son’s bedroom was small meaning that a lot of the care was being delivered in the main family living area. She felt she could not relax on her own home and was continuously making sure that the house was always tidy.
She found that she was always doing things such as getting meals and medicines ready, even though she was not asked to by the carers or obliged too. These factors meant that she could not switch off and was not benefitting from the service.
This home care package was reviewed and amended to provide a mixture of community care and care away from the home which met this family’s needs. Community care does suit many families.
One family I have worked with decided that they wanted home care based on a number of reasons. The first and main one being the reduction in risk of their son picking up an infection. Secondly for convenience, his morning routine of medicines, feeds and physiotherapy would have meant it would have been a rush to get everything done and travel to the hospice.
Add to this the very time-consuming activities of packing clothes, medicines, and equipment for their child to access respite outside the family home, especially for short respite, having someone come to the home was more practical for them and less time consuming.
Travel distance that some families is also a factor to consider, a long journey to pick up and drop off can significantly reduce the ability of parents to make the best use of the time their child is receiving care outside of the family. This issues of exactly who would be delivering the care can also be a factor to consider.
When delivering home care, as a hospice we would generally send out the same members of staff. Some parents preferred this, as they felt that these members of staff knew their child so well, whereas in the hospice the staff could change each time. By having the same staff in the home parents felt more at ease leaving their child and also those members of staff alone in their house.
As well as observing and providing successful respite care in the child’s home, I have also been part of providing short break care at the hospice.
The first time a parent would bring their child for either day care or overnight stay, many would also stay with them as well but take more of a back seat to the hands on care of their child, giving staff the opportunity to learn about their child whilst having the parent nearby in case they are needed. Some may only do this the first time while others would do this every time. It is very much an option that given to all families to accommodate everyone’s needs.
Although still in the building it means parents can still have time away to rest but are also close by so that if they wished they could come down to the main care area to see their child- for some parents this can help with their anxiety of having care from others rather than themselves.
One child I specifically remember came into the hospice on a weekend night every few months and his parents would also come. The mother had high anxiety of leaving her son with others however felt reassured that she could stay as well and was happy for us to take charge and lead his care, as she knew that we would come and get either her or the child’s father at any time during the stay if we had any questions and concerns.
They had their own separate bedroom with an adjoining bathroom which led into their son’s bedroom. The parents still liked to be part of the bedtime routine but were then able to step back and have dinner and the evening by themselves.
Due to the complex needs of the children and young people we looked after parents generally aren’t able to leave their child with a family member or friend. Many families also chose to have care in the hospice as it prepared them and their child for the future of possibly needing to use the hospice for end of life and after life care. It enables them to all become familiar with the staff and the hospice surroundings, especially for those with siblings.
For many parents having care away from the home means getting what they would call ‘a full break’. To leave their child and walk away for maybe even six hours can be hard, for many it can be a huge sigh of relief handing over the care and responsibility to someone else.
As well as benefitting the parents there are also many benefits for the children and young people of having care away from home. Socialising with friends can be exceedingly difficult for children with brain injuries and complex needs, and as their parents are main care givers they would have to come with their child on any social outing.
Like any child or young person children with additional needs don’t always want to have their parents around all the time, especially when being with their friends. This is where the hospice could step in to help meet the children social needs as well medical needs.
Many of the children who came to the hospice became friends either because they go to the same school together or through meeting at the family events which the hospice organises. Parents wanted to allow their children to have the same social experiences and opportunities as children of the same age who have no medical needs.
Following discussions with the families we would often plan for friends to have overnight stays together. For example, we would hold pamper evenings, movie nights and gaming evenings for friends and then they would both sleep over. Seeing the happiness in their faces when with their friends and giving them these social opportunities was one of the many highlights of my role.
Another key memory of mine was the celebration of a young person’s 18th birthday. He had wanted to go clubbing for some time and was eagerly awaiting his 18th birthday to do this, but again with his parents being main carers he did not want to do this with them. He did have contact with another boy of the same age through the hospice.
We were able to pre-plan with the two boys for a night out into town where they visited clubs and bars and then went back to the hospice for an overnight stay, all of which was supervised by hospice staff.
For a lot of the children and young people these are key events and memories in their life.
From my experience proving both community and hospice care, and from working closely with the families, there really is no right or wrong decision. All families will have varying needs and circumstances which will affect the decision they make on whether they have home care or care in a respite setting.
What I feel is most important is giving families that opportunity to have a choice and consider their individual options.
Building a network of support
Breakthrough Case Management traces the story of Aidan’s rehab journey
As a case manager with extensive experience in brain and spinal injury, when Catrin May was first approached by Asha Beswetherick of Enable law, to interview as a potential case manager for Aidan, (at the time, an 11-year-old child), she was naturally happy to be asked for her input.
However, as in most complex injury cases, she was under no illusion that the road ahead would be a smooth one.
Aidan had been born at 33 weeks gestation with the umbilical cord around his neck, resulting in an hypoxic brain injury and a subsequent diagnosis of cerebral palsy.
Cerebral Palsy is a neurological condition caused by brain damage either before or during birth. Potential issues a child might face include movement and walking disabilities; speech difficulties; learning disabilities; cognitive impairments; hearing or vision loss; epilepsy; emotional and behavioural challenges; spinal deformities; joint problems and more.
“For years,” Catrin explains,
“Aidan’s mother had felt that she was in some way responsible for her child’s injury and was frightened that if she made a claim, it would be proved to be her fault. Aidan’s father however, felt sure that it had been negligence and reassured Aidan’s mother, ultimately convincing her that litigation was the right thing to do for Aidan.”
Even once the family had made the decision to pursue the claim, Aidan’s mother had reservations about engaging a case manager to assist them through the process, concerned that she may lose control and not have a say in her son’s rehabilitation.
With a background as a Registered General Nurse, co-founder and director of Breakthrough Case Management, Catrin, has over 15 years of case management experience and understands the impact traumatic injury has on the whole family.
She is known for her compassionate, common-sense approach and a focus on the importance of collaborative work with clients, their families and clinical professionals.
“I would be being dishonest if I said I wasn’t concerned by the fact that Aidan and his family had had so little support outside of his family throughout his formative years” says Catrin.
“Ideally, in cerebral palsy cases, as with any complex brain injury, we would be looking to get a rehab programme in place as soon as possible after the index event. However, Aidan was 11 years old at the time I met him and his family. He was attending mainstream school and input from statutory services had been minimal, to say the least.”
“When I first met Aidan, he was able to walk a few steps but needed to be supported by either a walker or another person. His mobility was very poor. He wasn’t able to sit up in a chair. He had a wheelchair, but it was too small for him,” explains Catrin.
At the time, Aidan and his family; mum, stepdad and sister, were living in a house with an adapted downstairs bathroom, but his bedroom was upstairs.
“Aidan’s accommodation really wasn’t suitable for his needs; there was no hoist, despite Aidan being tall, his parents were carrying him, up and downstairs themselves, morning and night” says Catrin.
“Aidan has such a lovely family, (he also has a good relationship with his father) and their love and care for him was evident the moment we met. However, the situation was just not sustainable.”
When Catrin met Aidan, he was unable to drink out of a glass. He would use a straw but would make a mess when drinking and his choking risk was high. When eating food, Aiden would gag, and his mother would always have a bag at the ready.
“You can imagine that this made it incredibly difficult for the family to dine out, and so, often, they just didn’t,” says Catrin.
Although Aidan’s family were able to work out what he wanted, Catrin remembers being completely unable to understand his speech when they first met.
“As obvious as the need was for physio and occupational therapy, I knew immediately that we also needed to involve a Speech and Language Therapist as soon as possible” says Catrin.
It was important that it was someone who would give Aidan a sensory oromotor programme.
“At Breakthrough, we see our role as case managers as facilitators for partnership working, and this was certainly the case in this instance. Here was this lovely boy with a wonderfully supportive family doing their very best in a difficult situation. I was so eager to get the proper support in place for Aidan as soon as possible and start building the team that would come together to make a real difference to this boy and his family’s life.”
With many years of case management experience and wellestablished connections in the field of rehabilitation, Catrin was quickly able to put together a team of therapists and clinicians best suited to Aidan’s needs.
Catrin got in touch with Sarah Chatterton, Speech and Language Therapist, who started a sensory oromotor programme with Aidan that included a comprehensive exercise plan, practised five days a week with additional exercises at weekends. This quickly started to address his difficulties with eating and drinking independently.
At the same time Sarah also worked on Aidan's speech using an 'oral placement' approach to develop more accurate lip and tongue positions for individual speech sounds, along with transitions between speech sounds in words, phrases. sentences and conversation.
“Aiden and Krissy have been a joy to work with,” says Sarah.
“The success of the SLT programmes was wholly due to the practice that took place on a near-daily basis. Both Krissy and Aiden worked incredibly hard together to achieve the positive outcomes, both with eating and drinking and with Aiden's improved speech clarity.”
Alongside speech and language therapy, Catrin engaged an Occupational Therapist to review Aidan’s equipment. Having worked extensively with Gina Joslin in the past, she knew that the OT was well placed to make the necessary assessments and recommendations and ensure that Aidan had access to the very best assistive equipment.
“I knew Gina would be able to help improve Aidan’s posture and level of comfort and in turn, give him the greatest level of independence going forward.”
"Aidan and his mother were both encouraged to be actively involved with my assessment and decision making process so that they fully understood the goals the therapy team were aiming for” explains Gina.
“With the correct equipment - manual wheelchair, powered wheelchair, walker and a supportive easy chair, Aidan's posture, breathing and speech improved dramatically.”
It was also clear to Catrin that Aidan needed a comprehensive physiotherapy programme.
“I’ve worked a lot with Alison Fedeli in the past and I knew she would be a great physiotherapist for Aidan” explains Catrin.
“Being a case manager is so often about matching clients with the most appropriate or effective therapist for the client’s situation”.
Alison says she found Aidan ‘delightful’ to work with, noting “He is always willing to carry out his physiotherapy exercises and tries his best. Asha and Catrin helped him to set up a home therapy room and he has worked hard to strengthen his back, shoulders and legs. Aidan has gradually improved his posture, balance, walking and stamina.”
Aidan was very engaged in all of his therapy programmes from the outset and thanks to his efforts and the encouragement and support of his family, a lot has changed for the family in eight years.
Aidan and his family now live in a fully adapted home, featuring wide corridors for his wheelchair, a lift (Disney themed, which as Catrin notes, was ‘very important’), hoists, specialist bath and shower. Aidan can move independently within the home and access all areas without the assistance of his family.
Today, Aidan cycles at home daily and goes to the gym twice a week and also exercises in water.
His physiotherapist Alison explains that he is “encouraged to continue to work hard to keep the great gains he has made,” noting that it is “great to see how much he loves attending college and work experience. With improved mobility he can join in with fun activities and chat with his friends.”
Aidan is able to walk independently for short distances and sits up straight without support. Now able to eat without gagging and to drink from a glass, the family regularly go out to eat together. In fact, they recently took a family holiday to Disney World in Florida.
Aidan loves rugby and is a big Exeter Chiefs fan.
“When I speak with Aidan today, he can tell me his news and I understand everything he says” says Catrin, with a smile.
“He has a lot to say! He’s a happy, funny, positive person. Working with him and his family has been an absolute joy.”
“Aidan was late getting the full rehabilitation programme he needed, it is always beneficial to start rehab as soon as possible, however Aidan proves that big improvements can be achieved later on if you have the right rehab team in place.” Asha Beswetherick, of Enable Law agrees:
"The transformation I have seen in Aidan since acting as his Deputy alongside Catrin as case manager has been phenomenal. From being able to access equipment and therapies, having the right wheelchair to, what has probably been the most significant change, moving into his newly adapted home where Aidan has the space and facilities to support all his needs.
"As Deputy, I know Aidan's needs will change as he continues through his adult years but with the support of his family and an excellent case manager, he has a supportive team around him that certainly makes all the difference in making decisions on his behalf".
“Catrin is amazing. She gets me everything I need and want. I love talking to her.” says Aidan, who is well known at Breakthrough Case Management, for his positive outlook and his incredible smile.
“We love to receive photos from Aidan; whether it’s a family holiday photo, an outing to the rugby, a Christmas snap with his dog, or an update on his new garden ‘bar’ - it always features that smile,” says Catrin.
Krissy, Aidan’s mum is delighted with the impact Catrin’s input has made on her son’s and her family’s life. When asked what she would say to another family in the same situation being offered a case manager, Krissy explains,
“When he was eleven, I said I did not need a case manager.
"Now,” she says, “I say I couldn’t be without one.”
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