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July 22, 2011
Case managers are usually social workers or public health nurses who help coordinate the lives of people with HIV infection. People with HIV infection are in extraordinary need of help with work, home life, medical care, medical insurance, legal issues, finances, and psychological problems. Furthermore, people with HIV infection are subject to so many sudden changes in health that planning becomes difficult. Fortunately, the complexity of their needs has been recognized, and increasing numbers of organizations, programs, and other resources now satisfy these needs. The quality and quantity of these resources vary. Case management is a way of linking the people with HIV infection to the resources in their own communities. Working together with medical care providers, case managers commonly make two plans for each person with HIV infection: a medical care plan and a social work plan. The medical care plan includes plans for a range of continuing medical services, including home care, care in a clinic, hospital, nursing home, or hospice, and, when necessary, care in an addiction program or a mental health program. The social work plan includes financial plans, insurance benefits, benefits from publicly funded programs, resources for drugs, housing plans, and employment plans. The social work plan also links the person with HIV infection to community organizations that provide such services as support groups, home health care, companionship, meals in the home, and the like. The primary goal of the case manager is to be an advocate for the person with HIV infection. This means obtaining for the person with HIV infection all the services that are available and appropriate. A second goal is to obtain the best services at the lowest price. In short, a case manager knows the system, and his or her job is to make the best use of it. Case management services are sometimes funded by state health departments, by other sources of public funds, or by foundations. Insurance companies will sometimes pay for case management services. You can find out how to arrange funding for case management services by talking to the case manager or to a social worker. Both the availability and the quality of case management services vary widely in different communities. Some are not run as well as others. Some may not be networked into both the agencies that provide social services and the agencies that provide health care services for people with HIV infection. And even those that seem to be run well and well-networked are difficult to evaluate. Case management has been used to care for the elderly, for the mentally ill, and for crippled children; evaluations of the usefulness of these programs have been quite variable. As for HIV infection, there is probably no other disease in medicine where the fundamental philosophy of case management is more sound. Case managers can increasingly be found not only in comprehensive care programs but also in hospitals, clinics, state or city health departments, and community organizations dedicated to HIV infection. To find a case manager, ask if your hospital employs a case manager, and if not, if it will refer you to one. AIDS physicians and social workers will also know the names of the good case managers.*157\191\2*
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