Behind the Scenes Heroes - What exactly is a Care Manager?

In the following on-going series, we'll examine the work of care management, its role at GBCHS, and the truly amazing staff who are in the trenches day after day. Almost one third of Greater Cincinnati Behavioral Health Services employees are care managers (sometimes called case managers). But what exactly does a care manager do? In the following on-going series, we'll examine the work of care management, its role at GBCHS, and the truly amazing staff who are in the trenches day after day.

It’s first thing in the morning and Greater Cincinnati Behavioral Health Services Care Manager Kim Kendall is preparing for her first client of the day. Kim adds four new clients to her case load every week. She’s part of the GCBHS Housing Support Team which works with people who are homeless and in need of mental health services. The service is typically meant to be short–term. The team hopes to connect clients with housing and address immediate issues. Once their situation is more stabilized, the client can continue to receive services from another GCBHS Care Management Team depending on their particular needs.

On this morning Kim is meeting Richard for the first time. Richard is likely experiencing schizophrenia. He was admitted to the hospital after hearing voices that told him to kill himself. Currently on medication, Richard would like to find a place to live. On this first visit, Kim gets to know him. She finds out he has no family in the area, and he needs a phone. He has access to his disability benefits but no transportation. And he needs a primary care physician that will take his insurance so he can get his medicine.

There’s a lot of paperwork requirements involved with getting Richard the help he needs. They also go over a treatment plan and discuss when they will meet next. Richard has a difficult time remembering things so Kim helps him write it down. It’s obvious he is touched by her caring nature. He says, “Kim, you’re doing a great job.” Before he leaves she makes sure he has a card which tells him who to call and what to do if he’s “not feeling like himself.” Says Kim, “With so many people needing help, we have to tackle the most pressing issues. Typically it’s housing but with Richard, we also have to make sure he gets his medication so he won’t harm himself.” Richard promises Kim he’ll see her next week.

Before her next client comes in, she gets an emergency phone call. It’s a client who has had a setback and is drinking. He’s incredibly upset and tells her what a failure he is. Kim is calm and understanding. He tells her that everything he owns is in two garbage bags. “Are you safe,” she asks? “Yes,” he says. Then she says something he needs to hear, “Relapsing is part of your journey and your recovery. Don’t negate all of the hard work you’ve been doing because of this.” He begins to calm down and Kim asks him what he wants to do. She listens and tells him, “This is just one day in your life story. It’s okay.” He begins sobbing and thanks her profusely.

Kim works on paperwork with Michael to secure the housing he needs.

It’s time to see her next client, Michael. This is the first time Kim has met Michael, who seems upbeat and friendly but he’s been through a lot physically. A professional painter by trade, he suffered a heart attack and a stroke which left him in a coma. After coming to, he was without a business or a house. He has speech limitations which is frustrating for him. He knows the word he wants but it won’t come. He’s also dealing with partial paralysis of his hands and toes.

Michael is here with one mission in mind – he wants his own place and he has an application for a housing program. He’s excited until he finds out how long the waiting list is. (This is a recurring issue for people in need of housing.) If Michael can get into the program, he will only pay 30% of the rent, which is important for someone living on social security disability (approximately $750 a month or less). And it’s not just the waiting list; Michael also has a list of steps to do before he can even submit his application.

Michael is also out of his high blood pressure medicine, so Kim goes with him to pick up his prescription. It’s just part of the job. Care managers help people navigate the system. Says Kim, “When I started a year ago, it was a lot to learn. Where do you go for this certificate? Where are they located? What are the hours? Community resources change their procedures and if you don’t know that, it’s more time lost for you and the client, who doesn’t have time to waste. If I’m having trouble, can you imagine how difficult it is for someone who is homeless and without a car, has a mental illness and possibly other health issues?”

Kim and Michael waiting for a background check.

Kim takes Michael to the Justice Center for a background check and then to Job & Family Services for a printout of Michael’s benefits. It’s all part of the paperwork he needs for his application. Unfortunately that’s all they have time for, since Kim has other clients to assist that day. She encourages Michael to work on the additional items before they meet next week, but if not, Kim will accompany him to Social Security for proof of income, and verify he doesn’t have any outstanding utility bills. “You wouldn’t believe how that outstanding bill can mess people up for future housing,” says Kim. “I have a client we can’t get housing for, because she forgot to take the utilities out of her name and someone racked up over $15,000 in bills. How is she ever going to pay that?”

They get back to Shelterhouse (where Michael is staying). She tells him to go grab lunch and she’ll see him next week. Then she sits down at her table, checks her next appointment and she says, “Care managers have the honor of helping people through what is the most difficult time of their life. Most have dealt with abuse or major trauma. Every story breaks my heart.”