Care Management

• Registered social workers and/or occupational therapists who have been working in the community with seniors and their families and caregivers for many years.
• Able to coordinate care and support based on the result of their assessment. The assessment may be formal (using a variety of assessment tools) or it may be informal, based on our own observations and interactions with the client and their family. We also connect with various teams and other people that may work with the person already, so that we see the whole picture, and avoid duplicating efforts.
• Our client’s quarterback, and we provide the professional guidance to ensure everyone is on the same page as we all collaboratively develop and adjust the plan of care.
• Able to be there in a variety of ways for those without families and caregivers, or to support those who need extra support.
• Advocates and bridge builders in a health care system that sometimes operates in silos and only when things come to a crisis point. We try to be proactive and prevent crisis; we are also excellent at working through crisis situations.
• Knowledgeable about community resources, including how to access specialists, care at home, services from the public sector, and services from the private sector. We liaise, coordinate, and navigate between these services, taking into account the whole person and including nursing, Personal Support Workers (PSW), companionship, recreation support, music therapy, physiotherapy, and many others!
• Able to look at the entire person ─ holistically ─ including understanding their environment, physical abilities, functional abilities, cognitive abilities, emotional challenges, and impact on caregiving within the family and or community system.
• Flexible, creative and innovative, and always try to look at the strengths and abilities of those we work with, not only their limits, in order to bring dignity and quality to their lives. Furthermore, we try to always try to keep people’s values and goals at the forefront of our work, and to keep up with and implement evolving best practices when it comes to the care of those we work with and their particular needs.
• There to plan ahead and think about future challenges that may arise, and to see the “whole picture” while being able to be focused on the details of the here and now. In today’s Covid-related world, thinking outside of the proverbial ‘box’ and being innovative in our approach to care is paramount. We work to find the best solutions for you – our client.
• Independent and different from the case managers working at the provincial local health authority or in a hospital. These public sector case managers and discharge planners can only do so much, as their services are quite limited by large caseloads and time restrictions imposed by government budgets. Care managers at ECI carry a considerably smaller number of clients and are all supervised by our clinical social worker supervisor. We fill many gaps in our current public system, but also work collaboratively with it.
• Different from many home health care companies’ care management roles. We see their role as being quite different than ours. Home health care companies sell personal support worker hours; many families believe that the hiring of a personal support worker is the answer to everything that is needed. Bringing in a PSW may be only part of the solution. We examine all aspects of living well at home which often includes additional supports/services than the hiring of a PSW. We always recommend using a reputable home care company when hiring a PSW.
• Can act as “coaches” and do provide short-term counselling and mental health interventions as needed but refer out to psychotherapists and counsellors when longer term treatment is required.
• Recommended by satisfied clients, the public sector including Home Care, the Public Guardian and Trustee, hospital discharge planners, community-based programs and family doctors, as well as the private sector including lawyers, trust and estate financial advisors, employee assistance providers and businesses.

Did you know?

-Many extended health plans cover the services of a Registered Social Workers/Occupational Therapist.

-Registered Social Workers are authorized as ‘medical practitioners‘ under the Income Tax Act for the purpose of claiming medical expenses on income tax returns.