Aging-if it's not your issue [horizontal ellipsis] it will be!!" After reading this statement at the bottom of an e-mail, the simplicity and profoundness of it hit home. Personally, I have been noticing that famous singers, actors, and actresses of my teen years have been getting dramatically older (Sir Paul, who wrote "When I'm Sixty Four," turned 64 in 2006-how can that be?!!); my siblings' children have children of their own; and my peer group is struggling with aging and dying parents.
Professionally, the healthcare problems are accelerating exponentially. The first baby boomer collected her social security check in February 2008 and that signaled the era about which statisticians have been warning. In the annual summary of the latest statistics on the older population, A Profile of Older Americans: 2007 (AoA, 2008), some interesting numbers were reported:
* The older population (65 years of age or older) numbered 37.3 million in 2006, which is an increase of 3.4 million or 10.0% since 1996.
* The number of Americans aged 45-64 years who will reach 65 over the next two decades increased by 39% during this decade.
* Persons reaching age 65 have an average life expectancy of an additional 18.7 years (20.0 years for females and 17.1 years for males).
* Older women outnumber older men, with 21.6 million older women to 15.7 million older men; about half of older women (48%) age 75+ live alone.The future looks like this:
* The 65 years of age and over (35 million in 2000):
* In 2010 will increase to 40 million, a 15% increase
* In 2020 will increase to 55 million, a 36% increase
* The 85 years of age and older (4.2 million in 2000):
* In 2010 will increase to 6.1 million, a 40% increase
* In 2020 will increase to 7.3 million, a 44% increase
As society ages, it stands to reason that so are the case managers. It is noteworthy to look around the national case management conferences and guess the average age of the attendees. If you look at the second bullet above (The number of Americans aged 45-64 who will reach 65 over the next two decades increased by 39% during this decade), this could be talking about the majority of the current case management generation. After researching ages of case managers, I could only extrapolate them from the Commission for Case Manager Certification (CCMC) third case managers' Role and Functions Study in 2004, where it states that of those who answered the survey, the majority of the case managers' statistics were as follows:
* 21% were over the age of 56 (N 5 929),
* 47% were between 46 and 55 years (N 5 2,078), and
* 25.8% were between 36 and 45 years (N 5 1,142).
The study was in 2004, so add four more years to the ages. As for gender, 95.5% of the case managers were female (N = 4,224).
Also noteworthy is that 81.4% of the case managers were nurses (N = 3,598) (Tahan, Huber, & Downey, 2006). The nursing shortage situation is common knowledge and certainly adds to the challenges in this Editorial. A JAMA article written in 2000 stated that, within the next 10 years, the average age of RNs is forecasted to be 45.4 years, with more than 40% of the RN workforce expected to be older than 50 years (Buerhaus, Douglas, Staiger, & Auerbach, 2000).
So, what we have here is the Bermuda Triangle of case management (Figure 1):
1. an aging population in which more case managers are needed;
2. the aging of case management yielding less case managers; and
3. consumer and professional unawareness of the case management role (which will be labeled The Black Hole of Knowledge in the little diagram below).
This leads me to the title of this Editorial: A Call-to-Action for Case Management. Actually, it is a two-part petition. First, case management needs to better communicate with patients, healthcare providers, and regulatory bodies about what our work, our role, and the impact we have on their lives. Few case managers are unaware of the many definitions of case management and the difficulty articulating a role that is changing at light speed. Work has been done defining case management to the professional and consumer. But why is it not "sticking"? Use of good marketing and quality improvement techniques such as causal/barrier analyses and focus groups may be in order. Writing a definition is not enough. The next steps include learning how to market the information in a way that "catches on."
If the above is not accomplished, the Black Hole of consumer and provider awareness will surely lead to a deficit of case management if consumers do not request our services, if other healthcare providers do not understand case management's contribution to patient safety and quality of care, and if the regulatory bodies do not reimburse for case management services. If you feel this is not a significant problem, ask your mother, father, siblings, personal physician, or Congress(wo)man what a case manager is: listen to their response and look for recognition in the their eyes. Is it there?
Second, but no less important, case management must bring up the younger case managers with as much passion and commitment as we have had over the years. Rather than silos, we must continue to nurture a sense of common identity among case managers. This will take role modeling (of which there is no shortage), mentoring, and education.
Ah!! but we know that the devil is always in the details-how to accomplish these two formidable tasks; how to elevate the awareness of case management to the regulatory bodies, the consumers, and other healthcare providers; and how to garner the passion and commitment from the younger generation. First and center, we must keep ourselves clear and focused. In this issue's departments of Professional Case Management and HeartBeat of Case Management, the messages take us back to our roots where we feel recommitted and revalidated. Only then can we do the work of clearly and whole-heartedly bringing case management to consumers, providers, and the regulatory agencies. This is an important "first step." There are many "next steps"-and several of CMSA's Communities of Practice have made significant inroads.
Our generation of case managers is an awe-inspiring one. In grassroots fashion, we have been the change agents that broke the old molds and created new models. Even today, we are studying and researching what works, and what does not, to evolve into better, more useful models of care. We have passion, long-term commitment, and (what horse people call) heart-the steely determination to give the effort our whole heart. A Call-to-Action for Case Management, the two-part petition that will lay a strong foundation, is on the table. Healthcare and the patients need case management: we cannot risk that center of the black hole. It is up to all of us to move this forward.
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