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Fall 2014
Supervision in Care Management: Managing Quality

Managing Quality in a Small Agency: Supervision Model

About the Author

Helene Bergman, LMSW, is a Certified Geriatric Care Manager and owner of Elder Care Alternatives, a professional Geriatric Care Management business in New York City. She and her associate Care Managers provide comprehensive support services to older adults and their families in the greater New York area. She was previously affiliated with NYU Aging & Dementia Research Center, where she was a Family Counselor and a research associate. Helene has been a consultant for Nursing Homes and Day Care Programs to develop specialized programs for Alzheimer patients. She led many caregiver support groups for the Alzheimer’s Association and co-authored a book Guiding the Alzheimer’s Caregiver: A Handbook for Counselors. Helene frequently speaks on Memory & Aging, Alzheimer’s Disease, Caregiving, and Eldercare topics for Assisted Living Facilities, Nursing Homes, and corporations and is an ‘expert’ on blogs and Caring.com. She is a Fellow with NAPGCM (National Association of Professional Geriatric Care Managers) where she served on the Board of Directors (2006-2010). Prior to that, she was President of the Greater New York Chapter from 2000-2004.

Helen Bergman, LMSW, C-ASWCM

As a small care management business, I offer a supervision model that is dynamic and has evolved over the years from my experience as a supervisor for social work interns from the Hunter College School of Social Work in New York City, as well as professional collaboration and practice.  I have a two phase model: Phase One, training for new hire, and Phase Two on-going care management.

Phase One is much more time intensive and instructional. It begins with shadowing whereby the new hire accompanies a care manager to some complex cases and/or those to be assigned. This ‘on-the-job-training” demonstrates the comprehensive home visit and introduces all the facets of on-going care management. The 1:1 twice weekly sessions in month one, then focus on care management tasks, specific client needs in assigned cases, record keeping and most importantly job satisfaction. Gaining familiarity with the local area and its comprehensive resources (i.e. medical, social) is incorporated in the training. The new care manager’s caseload is gradually increased and overall mastery usually follows a learning curve of three months.

Throughout this phase and the next, the following Core Competencies are stressed:

Collaborative
Attentive
Responsive
Expressive

Multi-tasker
Adaptable
Non-judgmental
Available
Go-getter
Ethical
Responsible

Phase Two expands the educational content but is more tailored to individual need. Throughout this phase, there is close attention to the supervisee’s well-being and job satisfaction:

  • Weekly 1:1 session with agenda from supervisee and supervisor (group supervision if more than one employee),
  • Reading and approval of all emails to families/collateral following home visits,
  • Daily review of JewelCode (Professional Care Management Software) notes with feedback to supervisee [i]
  • Availability for ad-hoc support for problem solving (24 x 7), and
  • Periodic informal review of performance.

How does a Care Manager supervisee feel about the supervision model?

I asked two of my employees what strategies were most helpful and their recommendations for improvement. Here are their responses:

Most helpful according to the supervisees:

  1. The Agenda- there is consensus that this is beneficial. Keeping my own lists of “concerns” throughout the week to review when we meet is helpful to ensure nothing “slips through the cracks.” When the agenda of the supervisee was similar to that of the supervisor, it affirmed supervisee’s skill in assessment and self-evaluation.
  2. Use of software: JewelCode- To stay current on every client, utilizing the case list in JewelCode as the context to review each case one by one. Supervisees remarked that becoming familiar with all clients–even those they were not managing–increased their knowledge and skills and enabled them to cover when needed.
  3. Focus In on 1:1 sessions includes:
    1. Clear communication about expectations from care manager, caregiver, and family
    2. Guidance with prioritizing issues and cases/visits
    3. Giving both positive and negative feedback
    4. Focus on how to respect “boundaries” when CM is working with caregivers and clients
    5. Analyzing steps in problem solving; modeling for conflict resolution
    6. On-going education-always learning something new and full guidance in new situations
    7. Full support when having to deal with unpleasant caregiver issues
  4. Supervisor review of emails before sending (or responding to those from families/collateral) helped supervisee to write more concise summaries that are objective and do not cause alarm.  This technique was seen to increase the writer’s empathy with the reader and to avoid any confidential or liability issues.
  5. Ad-hoc availability to help problem solve and brainstorm, whether by email/phone/text, almost immediately.

Recommendations from supervisees:

  1. Supervise without interruption- Weekly sessions were usually interrupted by a client phone call, text, or email. While this became fodder for multi-task learning, it disturbed the continuity and focus.
  2. Moderate the education component–“too much to learn too soon” leaves one feeling overwhelmed and insecure.
  3. Provide additional help in resolving ethical conflicts over charging for services. This is especially important for social workers transitioning to a non-profit.
  4. Provide more focus on care manager self-care and boundary issues with clients, families, and caregivers.
  5. Include care managers more in business development; adding this component to supervision.

References

[i] “CareComplete Plus.” – JewelCode Corporation. Software. 01 Nov. 2014.

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