By Melinda Young

Case management leaders have been navigating another COVID-19 case surge. Angie Roberson, MSN, RN, ACM-RN, director of case management at Spartanburg Regional Healthcare System in Spartanburg, SC, works in one of the worst-hit counties in one of the worst-hit states during the late 2020 and early 2021 surge of COVID-19 that swept across the United States.

Hospital Case Management (HCM) asked Roberson to explain how her case management department has managed the surge and changes their hospital experienced during the crisis. Here are her responses, delivered via email, in this question-and-answer story.

HCM: During the pandemic, what have your case managers experienced as the biggest changes to pre-pandemic times?

Roberson: The changes have varied as the pandemic continued. Early on, not allowing visitors was a stark change. The job of case managers is to ensure patients and their care partners are involved in the care and transition plans. Restricting visitors meant we had to call caregivers to keep them informed. Case managers typically use all of their senses during conversations and assessments. Not being able to see a care partner’s face and reactions prompted us to rely on other skills. Some were able to use FaceTime and other virtual means, if possible. We are thankful that some visitors are now allowed, although it is limited, and we appreciate the ability to meet face-to-face again with care partners.

Another interesting change relates to patients and families who desire to go home vs. going to a skilled nursing facility for short-term rehab needs. More frequently, families are choosing home care with supportive services.

Many things are now being done virtually as opposed to face to face. For example, now that elective surgeries are performed at some facilities, patients are receiving virtual patient education prior to surgery rather than in-person classes.

HCM: What types of transitions of care have COVID-19 patients needed? How did case managers find the level of care patients required after hospitalization?

Roberson: Patients who were positive for COVID-19 have needed the same care and resources as patients without COVID-19. Home health, hospice, and skilled nursing facilities have been the most common post-acute resources. Because of this, in the early days of the pandemic, post-acute facilities and agencies worked diligently to make adaptations to safely deliver care to COVID-19-positive patients.

Locally, we have excellent relationships with our post-acute providers. That allowed for open conversations regarding the needs of hospitalized patients. I am proud of our healthcare system for working collaboratively with our local skilled nursing facilities. Pre-established relationships and communication have been key to finding the needed resources and solving any challenges.

HCM: As the pandemic continues and surges into the winter months, what preparations are your case managers and department making to handle what comes next?

Roberson: We are focusing on the well-being of our staff: offering virtual educational sessions and promoting self-care and the use of our employee assistance programs. We recognize that our associates are also dealing with the effects of COVID-19 on their families and life outside of work. We need to support our associates as the pandemic continues. Their health is critical to supporting the needs of our community.

Because we have several facilities in our system, our case management team is prepared to cross-cover in times of crisis.

Our knowledge of the local, state, and national situation allows us to be prepared as the pandemic continues. We are maintaining open lines of communication with community agencies and resources to provide support to one another.

HCM: Case managers at some hospitals across the country struggled to transition patients with COVID-19 to skilled nursing facilities, even with two negative tests. Was that something your department also experienced? How did you cope? Also, how will case managers handle it if that happens again?

Roberson: We were fortunate that two skilled nursing facilities agreed to set up units to care for COVID-19-positive patients who were ready for post-acute care. I credit open communication and established relationships. Currently, the CDC [Centers for Disease Control and Prevention] guidance no longer supports the two negative test strategy, and our local facilities are following CDC guidelines regarding accepting patients.

No matter the issue that arises, we will work collaboratively through open communication with our local skilled nursing facilities.

HCM: What are some lessons learned about how case managers can cope with crises, like this pandemic? As a leader, how have you helped case managers cope and prepare for further crises?

Roberson: Case managers are problem solvers, not only professionally, but personally, too. This means we sometimes carry a heavy load at work and at home. It’s critical to rest and lighten the load by taking care of ourselves.

We have proven throughout the pandemic how flexible and nimble we are. Recognize the team, say thank you often, and be kind, always.