By Jennifer Gazda, LCSW, CMC, CDP
Every day, we wake up and strive to provide the best care and advocacy for patients and their families. Our specialized training and ongoing education give us the skills necessary to complete this task. Hopefully, we will get the job done and then return to our families at night without the weight of the day still with us. But what happens when the patient you need to advocate and provide care for is at home? How does our role as case managers help and hinder providing care for a family member?
A couple of years ago, my husband was cutting the grass and stepped into a rabbit hole in the yard twisting his ankle. After my encouragement, he iced and limped for a few days and declined to see his primary care physician. I did not push for him to seek treatment as it was his choice and his pain, but in hindsight, I wonder if I would have let it go as simply if I was his professional case manager. Flash forward to January 2024 and he was still having pain and favoring his ankle, so I scheduled a "couples podiatry date," thinking we both would benefit from an assessment and custom orthotics and that would do the trick.
At the appointment, my husband received an X-ray as part of the general work up and the doctor was able to see a visible osteochondral lesion of the talus. The podiatrist recommended my husband see a surgeon for an ankle fusion or ankle replacement. Needless to say, we were pretty shocked, and I struggled with how my husband could be walking with such an injury for over a year. We saw two different surgeons who recommended different treatment options, and my task was to help gather information for my husband to be able to decide what he would like to do.
I researched all possible surgical interventions for the size of his lesion, which was 1.9 cm, and essentially, from the MRI image, it looked like someone took a golf club and cut a divot out of his ankle so his cartilage was dislodged. I consulted with people I knew in medical settings and reviewed quality of life studies from post surgical treatment. My husband was only 43 and we wanted to be sure we made the right choice. In time, my husband opted for a total ankle replacement and if it failed, we knew he could fall back on doing an ankle fusion. The replacement allowed for him to have better range of motion which was important to him.
While there was a minor complication with his surgery, and he needed to go back for a second surgery to replace a damaged tendon, he has since made an impressive recovery. However, there are two things I want to note. First, this story highlights a predominant issue in society of men delaying treatment or seeking preventative medical care. If my husband had sought care sooner, he may not have had as significant an injury, or there could have been additional options for repair. As case managers, we have to certainly respect our patients' decisions but we should be creating a space and setting in which it is safe for men to show their vulnerability.
Secondly, I missed a huge part of the recovery process when I was researching and supporting a family member instead of a patient or client. I was more focused on helping him make the right choice and what his post-care and recovery would look like to prepare. I did not prepare myself or my husband for the emotional journey that comes along with a significant surgery in which you cannot bear weight for weeks and his inability to work for about 9 months due to the nature of his job. Or maybe I did not realize it would be so difficult.
As we are helping to support patients and their families through treatments and procedures, I challenge us to keep in mind what happens when they leave our settings. Not all of us can follow these patients into their homes post care, so setting them up for success and assessing and providing referrals and resources for all possible outcomes is a great best practice. We also need to help support men's health initiatives and promote opportunities for them to seek preventative care and treatment in our day to day practice.
Want to get the most out of #CMSA2025? Start strong with pre-conference workshops on June 24!
These expert-led sessions will help you refine your writing skills, gain leadership insights, or prepare for your CCM exam—giving you so much value, before the main conference even begins!
Seats are limited—reserve yours today: https://cmsa.societyconference.com/
Bio: Jennifer Gazda, LCSW, CMC, CDP holds a Doctorate of Social Work from Aurora University and has dedicated the majority of her career to helping the geriatric population and their families. Jennifer has held the role of case manager in a variety of settings including child welfare, skilled nursing, and hospitals. Jennifer currently serves as Regional Director-Midwest for Arosa, provider of private care management and home care services across the country.