Dorothy Fairnot leads the reader through a discussion of focusing on the "whole person" while navigating the "benefits maze." First, when advocating for individuals who have sustained a work-related injury or who need treatment for occupational illness, the case manager cannot focus on the benefits system alone. They have to separate work-related injuries from preexisting conditions. Second, determine what the preexisting conditions are. Such as diabetes, hypertension, to name a few. Occupational injury may be covered by workers' compensation. But at the same time, there may not be group health coverage to treat preexisting conditions. Dorothy takes you through cases to develop guidelines to care for the total patient medical needs, again at the same time maintaining an ethical stance for each case.

Loretta Sandy provides a good argument to enhance quality care in the emergency room (ER) through the addition of a case manager, dedicated to the special needs of emergency medicine. She strengthens her position by discussing the following benefits:

* Proactive in determining that the patient meets medical necessity for acute levels of care and assisting with bed assignments to medical-surgical, telemetry, or intensive care unit.

* Facilitating transfer to either skilled nursing or rehabilitation facilities when acute inpatient is not in the patient's best interest or the patient's condition does not warrant an acute care hospital stay.

* Assessing the need for equipment in the home or other supportive services, when a patient is discharged home.

Loretta concludes her argument by leaving the reader with this image of the ER case manager: "who is an extension of the ER nurse and acts as a guide to assist the ER staff in understanding and managing barriers patient's encounter in complying with their discharge instructions and assisting patients to improve their health status and quality of life."

Paul Haulesser continues his tour of aging patients, friends and family members, for the reader. How he interacts with them is determined by his case management experiences. He concludes with the following rules that he developed over time:

* Listen

* Be present

* Be prepared

* Be realistic

* Be prepared for miracles

While reading this article, you may see yourself when you interact with friends and family members.

-Frances Snowden, BS, RN, CRRN, CCM

Contributing Editor