I couldn't be more pleased to have our special Guest Editorial to be written by Melanie A. Prince, MSN, BSN, NE-BC, CCM, FCM, FAAN. Melanie is the immediate Past President of the Case Management Society of America (CMSA) (2020-2023) and a retired Air Force Colonel. There is not a more fitting case manager than Melanie to start the CMSA Conference PCM Journal issue-which is all about our veterans. Thank you ALL (veterans and case managers) for your service.

Suzanne K. Powell, RN, MBA, CCM, CPHQ

"Thank you for your service!" ... a reverent phrase often rendered to men and women in uniform or people whose heads are adorned with hats from various military wars or campaigns, that is, Vietnam, Operation Desert Storm, etc. A phrase from a grateful nation that promised to care for veterans in sickness and in health. A nation that lives up to its promise with a wide array of services and benefits for veterans, who were willing to make the ultimate sacrifice for the protection, safety, and security of this country. As a 30-year veteran, I, too, am grateful for the sacrifices and service of my fellow service members and the opportunities granted by a nation that honors its veterans. And also, as a 25-year case manager, I am appreciative of the many ways case management can enhance the lives of veterans through the myriad of programs, services, and benefits within the Department of Veterans Affairs (VA).

The practice of case management allows a clinical professional to meet the needs of patients/clients at various points along the illness-to-wellness continuum as depicted by Dr. John Travis in 1972 (Wickramarathne et al., 2020).

According to the Case Management Society of America & Case Management Institute (2022) Survey Report, case managers function primarily in acute care and health plan settings. The acute care model of case management is typically hospital-based and supports seriously ill or injured patients/clients as part of a holistic treatment plan. Although case management typically occurs within the treatment paradigm and aims to facilitate patient/client's movement toward self-management, case management of the veteran often targets the wellness side of the continuum, in an effort to prevent movement toward the illness domains. For example, the VA case manager may address health education, social support, or transitional services to prevent illness or secondary exacerbation of an illness/condition. A case manager can not only assess the social determinants of health (SDOH) for a veteran but can also match needs with VA resources in all of the SDOH domains. (U.S. Department of Health and Human Services, n.d.) There are financial resources through the veterans disability program to address economic stability. Veterans can be connected to educational programs through vocational rehabilitation or GI programs. The Veterans Health Administration has a large integrated health care system of hospitals, clinics, community centers, and research institutions to provide comprehensive health care for veterans. There are VA programs that secure housing, adapt homes, and provide loans to purchase houses for veterans. And the last SDOH domain of social and community context is addressed through entrepreneurial workshops, employer summits, career transition programs, podcasts about holistic issues facing veterans, discounts at eateries, events and community programs, and tax-free shopping at commissaries and exchange stores.

If you are an acute care case manager, the VA's embrace of integrated case management affords excellent career opportunities. If you work in a health plan, transitions of care for veterans are seamless when you coordinate VA benefits and community resources. As a workers' compensation case manager, your skills are relevant for veterans who may benefit from vocational rehabilitation and work transition programs. If you are a life care planner, the VA has resources that address illness and wellness care throughout the life of a veteran, including mental health services. And when the end of life occurs, a veteran is honored with a dignified service in the national or a state memorial cemetery. The resources are available, and case managers must become aware of the plethora of services to address the rehabilitation, recovery, and restoration of veterans.

In addition to knowledge and awareness of VA resources, case managers must advocate for utilization and expansion of services tailored to the needs of a veteran. With rehabilitation services, this includes both physical therapy (PT) and occupational therapy (OT). PT programs are readily accessible in most VA markets. However, there is an apparent gap with ordering comprehensive OT services (both physical rehabilitation and mental health OT) in the VA market. Occupational therapists are educated at the graduate level and receive preparation to work in both physical rehabilitation and mental health from its inception. OT interventions are sometimes included under the umbrella of PT. This is not appropriate. OT is a separate and distinct profession and service from PT. In fact, OT was established in the United States in 1917, whereas PT was established in 1922 (AOTA, 2023; APTA, 2023) A recent conversation with an occupational therapist, a case manager, and a psychologist shed light on the importance of case managers understanding the distinction between PT and OT. OT is the therapeutic use of interventions that enhance everyday life participation and a client's valued occupations (activities a person needs to do, wants to do, or is expected to do). Occupational therapists have identified nine areas of occupation (AJOT, 2020). As stated previously, occupational therapists are formally educated to not only work with those with physical disabilities but also with those with mental health challenges. Their formal education at the graduate professional level addresses the behavioral sciences as well as the biological sciences, as compared with physical therapy, which is based on the physical and biological sciences. We would like to further suggest that encompassed in the OT division might include the expressive therapies such as music, art, horticulture, and dance. In the early years of OT after World War II, this was the case. These services would include the acquisition and preservation of occupational identity of servicemen and servicewomen, as well as veterans who have or are at risk for developing an illness, injury, disease, disorder, condition impairment, disability, activity limitation, or participation restriction. OT is a specialty area a case manager can champion within a comprehensive treatment or life care plan.

What is the point? The point is the acknowledgment of this nation's investments in the illness and wellness of its veterans through numerous well-known and little-known benefits, services, and programs. The point is a "callout" to case managers of almost any practice setting to influence the lives of veterans by using care management skills to identify, match, and enhance resources for the total care of veterans within all domains of SDOH. The points are as follows: (a) the nation honored veterans with a "promise kept" and (b) case managers are critical to making the "promise" a reality for thousands of veterans. Thank You for Your Service!

Acknowledgments

The author thanks Thomas F. Fisher, PhD, OT, CCM, FAOTA, Independent Consultant & Case Manager, Dean Emeritus and Professor Emeritus, Indiana University South Bend, for his contributions to this Editorial.

References