By Dr. Ellen Fink-Samnick DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCM
One of the biggest challenges for healthcare professionals is when our family and friends have a health crisis, and especially for those of us in case management roles. It is even worse when they experience an episode that warrants admission to any touchpoint of care, whether an emergency department, in-patient, rehabilitation, and/or homecare.
My mother fell on the Wednesday evening prior to Memorial Day weekend. She suffered an open fracture of her left wrist and dominant hand, and we were transported to nearest Trauma 1 facility. The healthcare team sprang into action! Their immediate focus was on my mother’s evaluation, diagnosis, stabilization, and treatment recommendations. The orthopedic resident and medical attending appeared quickly. An assigned nurse completed a preliminary assessment. A manual open-reduction of her wrist was completed in the ED, and by one of the most empathic practitioners I have ever encountered. Her medical care was exemplary.
Yet, over the next four hours, I found myself stepping into the advocacy role. I had to request the most basic necessities to assure my mother’s dignity. This included a hospital gown after she was left covered by only a sheet for several hours, a warm blanket to maintain her body heat, and some means to urinate. These seemed like easy requests that spoke to basic human need, yet the team still needed a cueing……Just Because I Can, Should Not Mean I Have to.
My mother was admitted to a room at 3 am and the nurses eased this transition by completing a swift preliminary assessment. The “screening” case manager contacted me by phone later that morning. She asked a series of questions, and those I had posed to countless families over the years. All of them were focused on my mother’s psychosocial circumstances prior to admission, especially her living situation, activities of daily living, and post-discharge arrangements. There were also a series of questions to address health-related social needs, which I knew all too well. I commented on my awareness of this assessment to the case manager; perhaps, I was trying to engage in a way that felt comfortable for me. However, the conversation felt scripted and reflected limited empathy or individuality of my mother’s reality.
I asked the case manager for a list of homecare agencies and was told that this resource would be provided by the unit case manager. I asked when this intel would be offered, especially knowing that the clock was ticking on my mother’s hospital stay. I thought it only fair to alert the case manager that I was familiar with the Medicare Conditions of Participation, and the timelines for this appropriate discharge planning options and information to be provided.
I also asked the case manager which case management certification she had; no answer was provided. I was given the first name of a case manager for the unit, then our call abruptly ended. I asked my mother’s nurse for the number of our assigned case manager, though was told that this person left had left at noon that day. The covering case manager was contacted by the staff, though nobody called back. I felt a sense of urgency rise within me…..Just Because I Can, Should Not Mean I Have to.
My mother had surgery on day 2 of her hospitalization. Communication by the surgical team and nursing staff was impeccable. Her orthopedic surgeon were very pleased with how mom faired in surgery and expected her to be discharged in 48 to 72 hours. The recovery room team was equally strong.
I became concerned about the discharge planning process and case management coverage during a holiday weekend. I had heard countless stories from colleagues and others how the word “planning” was rapidly disappearing from the discharge process; this vital action was reflective of a far more reactive approach rather than a proactive one.
There was still no communication from a case manager by the time I left the hospital that evening. I was equally aware of the stress starting to accumulate within my body. I was a worried daughter who was all too knowledgeable about the regulatory realities of health care delivery. Many of my closest friends are in case management, and several provided their support from afar. However, I continued to wonder whether the organization’s case management model allowed for this type of intervention. Supportive intervention was in my DNA, and not only because of my discipline of origin as a social worker. This was how I was mentored as a case manager by my nursing colleagues. Many of these individuals are among the legacy leaders of our case management profession….Just Because I Can, Should Not Mean I Have to.
I started to think of my expansive professional village, and who I might know employed by this health system. I hated to consider reaching out in this way but was feeling a high level of desperation to do something. As a case manager, then case management leader, I understood the importance for patients and their families to have knowledge of the care process. Providing information would inform their efforts and decision-making, while helping reduce some of the stress that comes from the care process. Having the facts are a basic element of informed consent, shared decision-making, and true discharge planning.
Sleep evaded me that night despite my exhaustion of the past several days. I kept feeling there was more that I should be doing to facilitate the planning process. After several hours of angst, I messaged a colleague who was employed for the health system as a case manager in acute care…Just Because I Can, Should Not Mean I Have to.
I awoke to a reply from my colleague, which instantly provided me comfort. Despite being off for the holiday weekend, she sent me a detailed message about how the organization’s case management model worked, and particularly during a holiday weekend. The physician’s order would drive the workflow, and ultimately, the case manager assignment. She then asked me a critical question. It was one that should not have been an issue, though made all the difference in the care that we received. “Could she inform leadership that a VIP was in-house?”
My initial gut feeling was a loud and resounding NO. Why should my reputation and standing in the professional community make any difference to the quality of case management intervention that my mother received? My husband stopped me from typing a quick and negative reply. He reminded me of the unfortunate reality that I had shared with countless others over the years. When families of health care professionals experience the care process first-hand, the quality of that process is empowered by what we know, as well as who we know.
I knew how easily patients can get caught in the bureaucracy a large health system, especially when the person is admitted to a facility where their primary care physician is not on staff. The response to my colleague was absolute: I appreciate the ask, and unfortunately we both know the realities for patients today. If you feel that this action would enhance my mother’s care, then please inform leadership.
A model case management process was initiated within hours. An empathic, knowledgeable case manager appeared on the unit. Her presentation balanced authenticity and respect for the patient and family’s dignity with clear information provided of our discharge planning options. By this point the interdisciplinary team had weighed in and felt that my mother would be an ideal candidate for acute rehabilitation. Our adept case manager followed-up with each facility and maintained steady communication with my mother and I. She checked in with me via email and in-person, always inquiring how was I doing as a daughter, and one caught between competing roles as an informed case management professional, a caregiver, and worried family member. She also provided me the sought-after list of certified home health and personal care providers. We were on a smooth path and transfer to acute rehab that Monday, or so I thought….Just Because I Can, Should Not Mean I Have to.
Small hiccups appeared upon our transition to rehab. We encountered a caring team, though blatant gaps in valuing the patient’s voice. My mother’s case manager stopped by on our first day at rehabilitation; we later spoke by phone. Her strong experience and credentialing had me optimistic, though we had little contact during the stay. One afternoon we met in the hallway, while she was chatting with the unit’s clinical psychologist. We had a brief discussion about my background and former case management roles for some of the clinical team. I let both of these individuals know that the patient was doing relatively well, though the family was a little stressed. Sarcasm is my way of coping, and identifiable to many case managers as a standard defense mechanism. I also mentioned that my fiercely independent mother was having an appropriately tough time coping and would benefit from a visit. The clinical psychologist agreed to stop by but never did…..Just Because I Can, Should Not Mean I Have to.
A stage one wound had been carefully managed for the past few years, advanced to a stage three wound. This shift was due to the all too common occurrence of new treatment recommendations provided by a well-intended team, which were counter to the prior successful interventions. My mother advocated loudly, and I reached out to her trusted dermatologist; her number was also provided to the team for further guidance as needed, yet nobody called her.
My mother’s wound care almost derailed her discharge, as the certified home health agency did not receive an order for a daily nursing visit for wound care. I reached out to the facility’s liaison, who quickly addressed the issue. Yet, the question again rose within me; what was the case manager’s role in coordinating care? The therapy team had recommended home physical and occupational therapy, and I verified with those team members what equipment to order; a bedside commode was arranged via the therapists. My husband and I ordered a travel wheelchair and shower seat online. I arranged personal care using the list of agencies provided by our capable case manager from mom’s initial hospitalization. My mother, her dermatologist, and several wound care colleagues advised me how to best address the wound. I am pleased to report it is healing well under the watchful eyes of a skilled home care nurse, and myself….Just Because I Can, Should Not Mean I Have to.
I set a high bar for the quality of all case management intervention, though acknowledge the challenges of providing it amid they obstructors of workforce retention, attribution, and burnout. I also recognize that there are a wide variety of case management models implemented across the industry’s transitions of care. Each model is guided by clear established resources of guidance, including regulatory and compliance measures (e.g., scope of practice for each license and discipline, accreditation and credentialing requirements, assorted laws), professional standards of practice, and codes of conduct. I have served as an item-writer for the CCM Exam, and the clinical-level social work licensure exam. I am a researcher, scholar, and educator at the masters’ and doctoral levels. I take seriously how those individuals entering our industry heed the Quintuple Aim of providing the right patient- and family-shaped care, at the right time, for the right cost, by those who embrace the work, and in a manner marked by inclusion and accessibility for all.
Yet, while I have the knowledge to advocate using case management’s regulatory, legal, and ethical practice guidelines, should not mean I have to engage this intel for use with my family and friends. What happens to those patients without a supportive family system? Patients are incredibly vulnerable and require our advocacy. This is why I will continue to advocate and ensure that all patients and their support systems receive the same quality of care, independent of my relationship to them. This action is among my highest callings and professional obligations as a Doctor of Behavioral Health (DBH), licensed clinical social worker (LCSW) and board-certified case manager (CCM)….Just because I can, means I always will.
Bio: Dr. Ellen Fink-Samnick, is a distinguished author, educator, and thought leader in the healthcare industry, who specializes in health equity, integrated care, interprofessional ethics, professional case management, quality improvement, and trauma-informed education and leadership. She is a faculty member, academic advisor, and the IRB Coordinator for the Doctoral Program at Cummings Graduate Institute of Behavioral Health studies. Dr. Fink-Samnick actively participates in a diverse range of national leadership and consultant roles within the industry. Her extensive academic contributions include authorship of six scholarly texts, over 100 articles, and other valuable knowledge content. She is recipient of CMSA’s 2025 Case Manager of the Year Award, the CMSA Foundation’s 2025 Research Award (with colleagues), and recipient of CMSA’s 2016 Award of Service Excellence. Dr. Fink-Samnick is also recipient of NASW of Virginia’s 2025 Lifetime Achievement Award, and the MSW Distinguished Alumni Award from the University of Buffalo School of Social Work