The average age of case managers continues to rise. Many are in their 50s and 60s, with the average being about 55 years (Case Management Society of America). This raises the issue of who will perform case management in the next 5-10 years. It also raises concerns in the current coronavirus disease-2019 (COVID-19) pandemic. Many case managers are functioning in leadership positions, others perform front-line positions. Some are relatively healthy, and others have comorbid conditions. There are case managers working in areas where the incidence of COVID-19 is low, and others working in "hot spot" areas with thousands of cases and deaths exceeding 30-35 per day. There are multiple factors facing each case manager in their daily job responsibilities. The aging case management work force has created a situation that has received little discussion or comment. What does a case manager of a "certain age" do when they feel performing their duties puts them in a situation where their personal risk is at an unacceptable level?

In reviewing the options, they are limited, and at times, impractical. The most drastic is resignation. This means a loss of income, and for many, a loss of health care coverage. In addition, many individuals are not ready to end their careers. Working from home is another option. Many organizations may not allow this option. The Americans with Disabilities Act may be an avenue for securing this type of accommodation, but requires completion of applicable forms, physician statements, and approval of Human Resources and Leadership. Continuation in the role, despite the risks, can increase anxiety and depression causing the individual to be less effective, or unable to function.

Many case managers have devoted years of their lives and career to this role. They have a strong sense of obligation and duty to serve during this public health crisis. This sense of duty and responsibility collides with the fear of risk, and a strong desire to serve to create feelings of guilt, and a sense of betrayal to their calling, and to their colleagues. This raises the question, "Must we sacrifice to serve"?

This question became very real for me, as I spent 12 hours in an N95 mask at a hospital screening station. I asked myself what I was doing there. I realized I was there because I was told to be there, agreed to be there, and felt obligated to be there. It was then that I realized that my sense of duty and obligation might be causing me to sacrifice too much. It was also then that I realized that I did not know how to serve without sacrificing.

The purpose of this department is to explore how case managers can serve without sacrificing. Mental health issues have become a major focus during the pandemic due to concerns such as those, the social distancing and isolation. Nothing has been written about the anxiety caused by case managers at higher risk performing duties that they feel are putting themselves and family members at unacceptable levels of risk. Some staff are calling out when they become overwhelmed, but this is a temporary solution to an ongoing problem. This situation calls for flexibility and compromise to continue receiving the benefits of the talent and dedication from this group of health care professionals. While some members of the health care team must be physically present in the hospital, case managers can serve multiple ways without sacrificing their health.

Some options available are:

* Zoom, or other web meetings: These are being widely used even for meetings where all of the participants are present in the hospital as a way to maintain social distance. They are also being widely used by individuals who would normally come to the hospital, but are limiting their exposure.

* Secure texting applications for real-time communication with staff and physicians

* Phone calls and conference calls

* Secure, encrypted e-mail

* Fax

* Document submission through applications and web portals

In fact, health plan case managers have used all of these successfully for years. Case managers of all ages have always been, and continue to be, innovators and problem solvers. All case managers should speak to their administration to advocate that they make the accommodations needed to allow the opportunity for everyone willing to serve to do so without sacrifice. We should also recognize those who are serving in alternative ways. Remember that many of these individuals care deeply, and are experiencing feelings of guilt. They are used to "doing whatever it takes," and it is counter to their very identity to be serving, or asking to serve in ways that are outside the norm. Now is the time to utilize all of our available resources by being flexible and innovative, and celebrate those who are willing to serve in whatever capacity they feel manageable.