EXECUTIVE SUMMARY

The pandemic exacerbated social determinants of health problems for many patients seen by case managers.

  • Case managers had to find new resources for patients, including aid from the CARES Act.
  • Colder weather, coupled with the economic fallout of the pandemic, also raised the likelihood of patients needing case management help with housing and food insecurity.
  • Telehealth has continued, creating opportunities to connect with patients more frequently, but also the challenge of follow-up when patients do not return for in-person visits.

Case managers in all areas found their roles were challenged since the COVID-19 pandemic started, particularly when it came to follow-up.

“Pre-pandemic, during the pandemic, and whatever the situation, follow-up is important,” says David Wilkinson, BSW, director of case management services at Central Behavioral Health in Norristown, PA.

The pandemic exacerbated social determinants of health for many people, including clients of Central Behavioral Health. Basic needs related to food, housing, transportation, and connection with others were more challenging in 2020, he notes.

Case managers had to work hard to make sure their clients were stable and to see if they needed to be connected to legal aid or to community-based organizations that received pandemic funding through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, he says.

The CARES Act was signed into law on March 27, 2020. The $2 trillion economic relief package includes assistance for state, local, and tribal governments, as well as direct funds for individuals and small businesses. (More information is available at: https://home.treasury.gov/policy-issues/cares/state-and-local-governments.) Local governments often provided community-based organization grants related to education and other services affected by the pandemic. The CARES Act directly provides sector-specific aid for nonprofit services that include food banks, legal aid, arts and humanities, substance abuse and mental health, and children and families.

“If a person is over age 60, then maybe they need subsidized housing, Meals on Wheels, or in-home support,” Wilkinson says. “As a case manager, part of the effort is to be aware of their needs.”

As the weather grew colder and the pandemic brought more COVID-19 surges, hospitalizations, and economic hardship, case managers also had to be on alert for patients who were homeless and in danger from freezing temperatures. Case managers should continue to be on the lookout for patients experiencing food insecurity and rental evictions, Wilkinson notes.

“We’re concerned we’ll see an increase in evictions,” he says. “There has been an increase in food connection needs and food resource needs in the community.”

Case managers should provide clients with information about local food pantries and soup kitchens, as needed. “In our continued follow-up with people, if someone is out of food, we may go to a food cupboard and get some food for them and safely drop it at their door,” Wilkinson says. “We follow CDC protocols with wearing masks and staying distant.”

Telehealth Continues to Grow

Telehealth is continuing through the pandemic. Case managers should look for technology gaps among patients. “When clients have a smartphone or computer, it has helped a lot, even when they’re seeing their therapist or psychiatrist,” Wilkinson says. “It’s important to see them, and it’s true from the case management standpoint, too.”

Second to that is for case managers to stay in touch with clients via phone calls. However, case managers can find follow-up is difficult when patients are not keeping their in-person appointments, and phone calls go unanswered. If a patient’s situation might be urgent, case managers may need to decide how they could safely track down the person.

“From a client care standpoint, we need to look to see if there are gaps in care, and we need to get our eyes on the client,” Wilkinson says. “If you have video [visits] it helps a lot, too.”

One important gap that has repeated itself throughout the pandemic relates to increased isolation. “Many clients are fearful of catching COVID, and that definitely has increased,” he says. “Also, I don’t have data, but I think one of the things that has happened is an increase in substance abuse situations.”

An Oct. 31, 2020, report from the Advocacy Resource Center of the American Medical Association noted that more than 40 states have reported increases in opioid-related mortality and ongoing concerns for people with a mental illness or substance use disorder. The 20-page issue brief included 19 pages of media headlines and links to articles about overdoses and substance abuse. (The report is available at this link: https://www.ama-assn.org/system/files/2020-11/issue-brief-increases-in-opioid-related-overdose.pdf.)

Case manager leaders can help mitigate this unfortunate phenomenon by advocating for local pharmacies to carry Narcan, the drug that reverses opioid overdoses. Case managers could see if clients need a prescription for Narcan in the event of an overdose emergency. They also can keep track of substance use rehabilitation facilities and their availability to take on new clients.

“Educate people around this, mitigate some of the risk, and help them with access to Narcan to reverse the effects,” Wilkinson says.