What Does A Case Manager Do?

Helen*, an 85-year-old Aetna member, was diagnosed with lung cancer. Her doctor gave her a grim choice. They could try to prolong her life for a few months with chemotherapy or she could skip treatment. Helen and her husband Fred knew that chemotherapy could lead to hair loss, fatigue, nausea and vomiting. They also knew that chemotherapy might prolong Helen's life, but it would not save it.

A Guiding Hand
Barbara Siso, R.N., is an Aetna case manager. She was alerted to Helen's diagnosis. Barbara called and spoke to Fred. Fred said they were worried that chemotherapy would make Helen miserable and only extend her life a short time.

"As a case manager, my job is to make sure a member is fully informed," Barbara said. "This wasn't the case with Helen and Fred. They needed some guidance."

Barbara discussed hospice with Helen and Fred. Hospice provides care for people with life-threatening illnesses who have a limited life expectancy. Helen and Fred knew little about hospice. None of Helen's doctors had mentioned it.

"If Helen chose not to have chemotherapy, she needed to understand that there are options that would support her," said Barbara.

Barbara's actions reflect her nursing instincts and the training she received as part of the Aetna Compassionate Care Program. The program provides case management, advance planning tools and information. In some cases, it offers expanded benefits to Aetna members and their loved ones.

The Right Choice
Barbara learned that Helen and Fred decided against chemotherapy. Helen signed up for hospice care.

Helen passed away after almost seven weeks in hospice. Fred thanked Barbara for the support and information she provided. Fred told Barbara that Helen died peacefully and without pain. Fred planned to join a hospice support group to help him with his grief.

*Names and some details have been changed/omitted to protect privacy.