Behind the Scene – Care Management

September 17, 2021

Not every member of the Shore team puts in an IV or mends a broken bone in caring for our patients. A very important part of the compassionate care our patients receive happens behind the scenes through the dedicated work of the care management team. “We are involved with patients from birth through end of life,” said Administrative Director of Care Management and Social Services, Christine Bracey.

The care management team has 25 members that include Social Workers, RN Care Managers, Director of Care Management, Dr. Charles Dennis, Physician Advisor, Care Manager Assistant and business associates. Their duties have them interacting with patients each day of their stay in the hospital. “We interface daily to meet patient needs and family goals to get them back to their previous lifestyle,” said Bracey.

Members of the care management team work toward the best possible outcome for each patient. They put together successful discharge plans for the patient and work with insurance companies for verification of coverage and multiple agencies such as the New Jersey Div. of Child Protection and Privacy as well as addiction treatment facilities, Long Term Care/Rehab facilities, Hospice,  Home Care and mental health agencies. When there are mental health issues, homelessness, and guardianship challenges, the care management team is in the mix to lay out the best possible scenario for each patient.  Sometimes that will mean working with attorneys, physicians, and law enforcement. They set up home care once the patient is discharged and that might include anything from assuring the patient has home IV infusion care, oxygen being delivered, and home nursing care. If necessary, follow-up appointments are made, all before the patient leaves SMC. Care management also works in close contact with the palliative care team and with families through the Caregivers Center offering information as well as support.  When involved with patients and families during end of life situations, the care management team works diligently to ensure death and dying with dignity for those patients at the end of their lives.  

The strain of the pandemic presented a challenge to the care management team but the members worked through it to provide the compassionate care that is a hallmark of Shore Medical Center. “The impact our department makes on a patient’s family sticks with them,” said Bracey. “It comes from their heart and wanting to advocate for patients the best they can so that each patient has the most appropriate discharge plan to live a productive life. Each member of our team truly cares.”  

“This dedicated group of professionals come to work every day, showing up with humility while giving their best to help people who are most vulnerable,” said Bracey. “I am very proud to work with a team that is dedicated and compassionate about the safety and well-being of our community and each other.”