CMSA Today - Issue 7, 2016 - 26


remainder to provide services beginning Jan.
1, 2018 (CMS, 2016). An interactive map and
further information about the Medicare Care
Choices Model can be viewed on its designated
website, at https://innovation.cms.gov/
initiatives/Medicare-Care-Choices/.
Finally, a number of third-party payers
have recently expanded homecare benefits
and other programming for cancer and
patients who qualify for hospice and often
palliative care. An increasing number of
insurance companies cover the costs of visits
to mental health practitioners for patients
and family members to address counseling
issues specific to the illness course and dying
process (McCluskey, 2015; Miller, 2016; Taylor,
et al., 2015). The times are definitely changing
with respect to care access, coverage and
more comprehensive management of endof-life care.

ACTION ON THE HORIZON
Four states have formal Death with
Dignity legislation in place at the time of
this writing: Oregon, Washington, Vermont
and California. In Montana, the end-of-life
option is legal through the state Supreme
Court ruling (Death with Dignity National
Center, 2016). Staunch efforts are occurring
across the states to pass new laws to enhance
the quality of intervention and available
options for those persons maneuvering the
end-of-life process. The legislative landscape
is a moving target. There are still 27 states
that have no legislative activity this year
or session. An interactive map of current
legislative happenings can be viewed on the
Death with Dignity National Center website,
at https://www.deathwithdignity.org/
take-action/.

CONSIDERATIONS FOR
PROFESSIONAL CASE
MANAGEMENT
Today's professional case managers must be
proficient in new reimbursement strategies,
ever-expanding resources, plus definitive
strategies to intervene effectively with their
patient populations engaged in end-of-life
care. The ethical tenets play a strong role in
this endeavor, particularly those of autonomy,
nonmaleficence, and fidelity. It is the case
manager who dialogues directly with the
26

CMSA TODAY

patient about his or her end-of-life choices.
It is the case manager who advocates for
the patient's unique circumstances to be
considered by the interprofessional team, as
they reconcile the most appropriate treatment
options and plans. Finally, it is the case
manager who has a primary obligation to his
or her clients, assuring all are treated fairly with
regard to gender identity, race or ethnicity,
practice, religious or other cultural preferences,
and/or socioeconomic status (CMSA, 2016).
While all of the CMSA Standards of Practice
for Case Management (2016) are applicable
for professional case managers who intervene
with the end-of-life population, those with
specific relevance include:
* B - Client Assessment
* C - Care Needs and Opportunities
Identification
* J - Legal
* K - Ethics
* L - Advocacy
* M - Cultural Competence
* N - Resource Management and Stewardship.
Each one of the above standards affirms
the integral right of patient individuality and
autonomy through unique assessment of his
or her unique cultural context. Assessing the
interplay of medical, cognitive and behavioral,
social, and functional components to comprise
each patient's reality serves as a principal
competency for case managers. The ability
to monitor and orchestrate proper resource
management, while assuring high levels of
advocacy as needed, is equally vital.
In the context of ethical case management
practice, shared-decision making (SDM)
provides the solid foundation for professionals
to engage in a structured process which
promotes sharing of key information with
patients and families while respecting their
individuality (Elwyn, et al., 2012; Fink-Samnick,
2016b). The process involves collaboration in
that it provides patients and their providers
the opportunity to make healthcare decisions
together, taking into account the best scientific
evidence available, as well as the patient's
values and preferences (Informed Medical
Decisions Foundation, 2016). Respect for
patient self-determination and autonomy
is paramount.
Several models have been created for
practitioners to engage in SDM with patients

Issue 7 * 2016 * DIGITAL

and families, guiding what can present as
an emotionally laden and complex process.
Among these valuable resources is the Three
Step Model (Elwyn, et al., 2012), which involves
the following phases:
1. Choice Talk: Make sure patients know
reasonable options are available
2. Option Talk: Provide more detailed
information about options
3. Decision Talk: Support the work to consider
preferences and decide what is best
A fresh rendering of SDM for professional case
management (Fink-Samnick, 2016b) provides
an essential fourth step called Touch Back,
with the model shown in Figure 1. This revision
provides those persons involved in these
intense conversations an extra opportunity
to review where dialogues end and then define
any further information needed to advance, if
not complete, the decision-making process.
The fourth step provides case managers the
chance to intervene in one final Touch Back
interchange with the patient and/or family.
Those involved with this population know the
difference that a single final interaction can
make, often becoming the most meaningful
element in achieving resolution of a complex
decision-making process.

Figure 1: The Shared Decision Making
Four Step Model for Professional Case
Management (Adapted from Elwyn, et al.,
2012, Fink-Samnick, 2016b)

NEXT STEPS
This concludes Part 1 of this article series.
Watch for Professional Case Management's
Ethical Quartet for 2017: Part 2, Technology/
Social Media and Mandated Duty to Warn in
Issue 1 for 2017. ■
Ellen Fink-Samnick
MSW, ACSW, LCSW,
CCM, CRP, is Principal
of EFS Supervision
Strategies, LLC. Known
and respected as "The
Ethical Compass of
Professional Case
Management," she is a popular presenter and
esteemed author with over 80 publications to


https://innovation.cms.gov/initiatives/medicare-care-choices/ https://www.deathwithdignity.org/take-action/

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2016

PRESIDENT’S LETTER
ASSOCIATION NEWS
CMSA CORPORATE PARTNERS
Are You Culturally Competent?
Return to Culture – Return to Healing
Appalachian Culture: A Guide for Case Managers
Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
Diversity of Role Reversal: When the Case Manager Becomes the Patient
INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover1
CMSA Today - Issue 7, 2016 - cover2
CMSA Today - Issue 7, 2016 - 3
CMSA Today - Issue 7, 2016 - 4
CMSA Today - Issue 7, 2016 - 5
CMSA Today - Issue 7, 2016 - PRESIDENT’S LETTER
CMSA Today - Issue 7, 2016 - 7
CMSA Today - Issue 7, 2016 - 8
CMSA Today - Issue 7, 2016 - 9
CMSA Today - Issue 7, 2016 - ASSOCIATION NEWS
CMSA Today - Issue 7, 2016 - 11
CMSA Today - Issue 7, 2016 - CMSA CORPORATE PARTNERS
CMSA Today - Issue 7, 2016 - 13
CMSA Today - Issue 7, 2016 - Are You Culturally Competent?
CMSA Today - Issue 7, 2016 - 15
CMSA Today - Issue 7, 2016 - Return to Culture – Return to Healing
CMSA Today - Issue 7, 2016 - 17
CMSA Today - Issue 7, 2016 - 18
CMSA Today - Issue 7, 2016 - 19
CMSA Today - Issue 7, 2016 - Appalachian Culture: A Guide for Case Managers
CMSA Today - Issue 7, 2016 - 21
CMSA Today - Issue 7, 2016 - 22
CMSA Today - Issue 7, 2016 - Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
CMSA Today - Issue 7, 2016 - 24
CMSA Today - Issue 7, 2016 - 25
CMSA Today - Issue 7, 2016 - 26
CMSA Today - Issue 7, 2016 - 27
CMSA Today - Issue 7, 2016 - Diversity of Role Reversal: When the Case Manager Becomes the Patient
CMSA Today - Issue 7, 2016 - 29
CMSA Today - Issue 7, 2016 - 30
CMSA Today - Issue 7, 2016 - 31
CMSA Today - Issue 7, 2016 - 32
CMSA Today - Issue 7, 2016 - 33
CMSA Today - Issue 7, 2016 - INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover3
CMSA Today - Issue 7, 2016 - cover4
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http://www.nxtbook.com/naylor/CMSQ/CMSQ0413
http://www.nxtbook.com/naylor/CMSQ/CMSQ1413
http://www.nxtbook.com/naylor/CMSQ/CMSQ0313
http://www.nxtbook.com/naylor/CMSQ/CMSQ1313
http://www.nxtbook.com/naylor/CMSQ/CMSQ0213
http://www.nxtbook.com/naylor/CMSQ/CMSQ1213
http://www.nxtbook.com/naylor/CMSQ/CMSQ0113
http://www.nxtbook.com/naylor/CMSQ/CMSQ1113
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1412
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1312
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1212
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1112
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1411
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1311
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1211
http://www.nxtbook.com/nxtbooks/naylor/CMSQ0111
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1111
http://www.nxtbookMEDIA.com