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In the early 2000s, Cheryl Acres, RN, CCM, was working for a group health organization and was managing the care and benefits for a woman who had a catastrophic stroke when an attorney she consulted asked her, "Why are you doing this for someone else? You should be in business for yourself."
"It took me three years to go out on my own, but the seed was planted. It is a very big leap to go from having a salary, health insurance, and a retirement plan and working in a structured environment. But here I am seven years later and I love my job," says Acres, owner of Comprehensive Care Management, LLC, an independent case management company based in suburban Dallas.
Acres started her nursing career in 1978 and worked for hospitals and in home health before becoming a group health insurance managed care case manager in 1996 and earning her certification in 1998. She transitioned to worker’s compensation case management, but in 2000, she joined a group health case management company.
Her first case management business was a partnership, but that didn’t work out. After about a year, Acres ended the arrangement and formed her own company in 2007.
Acres started by registering her company’s name with the county and working on a business plan. "I’d never been in business for myself, so I was doing it by the seat of my pants. I did a lot of research and met with the Small Business Administration to find out what resources they could offer," she says.
Through the U.S. Small Business Administration, Acres found the Dallas chapter of the Small Business Development Service Corps of Retired Executives (SCORE), a volunteer organization of retired or active business owners who provide training and workshops for people starting their own business.
When Acres started her business, she utilized her savings and worked two days a week as a hospital case manager to earn enough to pay her bills until her business was profitable. She also became an assessor for a long-term care insurer and continues taking assignments from them.
"These two jobs allowed me the flexibility to market my services and schedule patient appointments during my off time," she says.
Acres got her first clients from referrals by friends and her fellow members of the Dallas-Fort Worth chapter of the Case Management Society of America. "A lot of my clients came by word of mouth. I did some marketing to senior networking groups and service providers, elder law attorneys, and spread the word among my case management friends."
The majority of Acres’ workload is coordinating and managing care for seniors, but she does have younger clients with conditions like multiple sclerosis and early-onset Alzheimer’s disease. Her youngest client is 30, but several clients are in their 90s.
She describes herself as "a project manager for healthcare and the aging." As an independent case manager, she contracts with individuals or their family members to identify problems and solve them, help clients navigate the healthcare system, and ensure that all their needs are met.
She often attends physician appointments with clients to facilitate communication, manages their prescriptions, fills medication boxes, and educates patients on their conditions and treatment plans. She checks regularly with clients in nursing homes or assisted living facilities to make sure everything is going smoothly, and attends care conferences at the facilities. When her clients go to the emergency department, she’s on hand to inform the treatment team about the patient history.
"I occasionally review insurance plans and healthcare bills. I may have to find community resources to help with meals and bathing or arrange for a wheelchair ramp or other home modifications. It’s all very individual and depends on what the client needs and wants," she says.
When Acres gets a referral, she offers a 20- to 30-minute free telephone consultation to the client to determine if she can meet the patient’s needs. Once she gets a contract, she conducts a comprehensive assessment in the home or facility that includes a review of the medical history and current medications, and a home safety evaluation.
As part of her assessment, she researches the medication patients are taking and makes sure that all of the prescribing physicians know which medications their patients are taking. She makes a list of current medications and makes copies for the clients to give to their providers.
She educates her clients on their conditions and on the importance of following their treatment plan and taking their medication as directed. "Many patients don’t understand their conditions, and their physicians have limited time to teach them," she says.
After the assessment, Acres develops a care plan that includes current needs and what to expect in the future, and shares it with the clients and their families. "I try to incorporate the clients’ wishes in the plan. Almost all of my clients want to stay in their home. The care plan focuses on keeping them safely where they want to be and at maximum health. It’s a kinetic plan that can change in a heartbeat. I constantly monitor the situation and alter the plan as the situation changes," she says.
Sometimes the clients’ wishes aren’t realistic, Acres says. "I have to be the bad guy and give them a dose of reality," she says.
Acres charges a flat fee to evaluate clients and develop a plan and charges an hourly fee for ongoing services.
She sees her clients as often as needed, depending on their acuity. "In the first month, I usually see clients frequently, but then I get the situation sorted out and may see them only once a month," she says. Some long-term care insurance covers care coordination. In those cases, Acres helps clients file a claim.
Acres works out of a home office using a dedicated smartphone as her work phone. She takes an electronic tablet with her when she visits clients. "I use this as an educational tool and to do research. I still use paper charts because patients see a laptop as a barrier," she says.
She does all her own billing using a bookkeeping program, but has hired a certified public accountant to handle her expenses and taxes.
Acres takes every opportunity she’s offered to educate the public on what case managers can do for them. "People in general don’t understand case management. They may have an experience with a case manager in a facility or who works for an insurance company, but they aren’t aware that there are case managers in the private sector," she says.
She speaks on issues concerning the aging at independent living seminars and to community organizations and recently was interviewed on her local Public Broadcasting Service for a series on broken hips.
She has a website (www.txcasemanager.com), a Facebook page, and a Twitter account. She is active in the local chapter of CMSA and belongs to the National Association of Professional Geriatric Care Managers, which offers consumers a database of elder care resources.