Fourteen weeks of hell

While VAC is moving full-steam ahead on the new Rehab Contract, here’s what one Case Manager told us the next 14 weeks are already like for them and their colleagues. Here’s their story.

Work Hours during this period525
Minus Average 2 week vacation-75
Scheduled Meetings (regular IDT, Committee meetings, CM meetings)-15
Community of practise meetings-2
Intake Hours (minimized hrs
see noteIntake hours are listed as half of what is actually assigned to case managers. I cut the time in half because we are not busy on intake all day. We have to be available all day for intake and we are not allowed to make calls to our assigned clients on these days. I cut it in half because the time working on intake files is unpredictable. One intake item can take all day and spill over into the next day when staff are not on intake. A Veteran’s emergency fund that comes in on intake can take most of the day. Some days it is quiet and some days it is busy with intake because we are answering call and following up and documenting in the client files. It is unpredictable but I would say that on average, have of the time that we covering intake it is busy.
Mandatory CMAT /Sept 30….. 5 hrs approx.
(see note)Mandatory Case Management Assessment Tool (CMAT) was rounded to 5 hours per assessment. This is referring to the assessments that are mandatory to complete on all clients by the end of September 2022. The average time spent with the client asking clients the questions is about 2.5 to 3 (it is important to note that some staff have had to schedule multiple appointment s to try to get thorough the assessment with some very sick Veterans. They have reported approximately 5 hours with the Veteran simply gathering the information). Afterwards, the CM has to tidy up the assessment, add the client needs, add the recommended resources, do an analysis and determine what conditions will be case managed and what conditions will be rehab. The case manager then has to follow up on any missed needs for existing clients. If the client is new, then the CM has to get signed consents approve assessments and locate providers for the Veteran to access treatment. Most of the assessments can take much longer that 5 hours. Management has said that older files should not take more than 15 minutes but with the file clean up blitz, few of us have those older files. This estimate on the hours needed to complete these CMATs is based on a Case load of 40 clients and does not include the CMATs that have to be completed when a file is referred for case managed services only. Some CMs may have more than 40 files.
Mindfulness weekly and wellness hour monthly encouraged to take for MH-10
Office days – soon will have scheduled appointments-105
Bi-weekly meetings with VSTM-7
Total hours remaining69

Every 2 weeks, Case Managers also meet with their VSTM to discuss any issues.

This leaves Case Managers with 69 hours over the course of 14 weeks to do the following:

  • New RROD assignments (adjudicating on new applications) these applications come in regularly and some of them are very lengthy with some Veterans applying for up to 20 conditions and CMs need to consult with coworkers or with a subject matter expert to adjudicate on some conditions.
  • Open new files and complete CMATS with these newly assigned clients (this is not included in the number above), locate and refer new clients to providers and complete goals and 6 step decision making process for each provider referral. 
  • Consulting with Subject matter experts for various reasons because a situation does not clearly fall within the parameters of the business process
  • Consulting with junior staff that require assistance with something as part of their learning
  • Work items assigned to the Case Manager through CSDN
  • Tasks that come in through GCCase
  • Referrals to CVVRS (vocational contractor) (Canadian Veterans Vocational Rehabilitation Services – CVVRS)
  • Referrals to DEC (Diminished Earning Capacity)
  • File Closures ( the NCA has a tiger team that is suppose to help with file closures but the CM has to go in and review all of the file and send a summary to the tiger team.  The only time that this saves the CM would be the time spent writing the letter, about 10 to 15 minute max.  To try to have you believe other wise is an absolute farce.  Most CMs will not even refer their files to the tiger team because they don’t have time to review and prep them for someone else to close. In addition to this, if they are reviewing the whole file, it doesn’t take any longer to click complete on each item as it is being reviewed. 
  • Respond to MS teams
  • Respond to emails
  • Keep track of the numerous SDAT (Service Delivery Advisory Team) updates that contain important updates about our work and how to do our jobs.
  • Respond to Veterans through MyVAC account
  • Respond to Veterans by telephone
  • Extend resources for providers.
  • Follow up on recommendations from assessments from nursing staff and OT staff
  • Case managed referrals that require inpatient referrals and CM has to collect the information and present to IDT (interdisciplinary team) and all other steps to have inpatient treatment approved.
  • Update goals in GCcase
  • Review provider reports, write a summary and follow up on recommendations. Upload reports to GCCase
  • Complexity assessments that will be determined by the original CMAT assessments.
  • Approve resources and write letters informing client and providers of resources approved (1 letter for each)
  • Attend training
  • Collect answers and respond to Veteran’s questions about their financial benefits and their disability applications because staff from the financial department do not speak to the Veterans.  This usually does not end after the first questions are answered and the CM frequently has to go back and forth to get the information to explain someone else’s decision to the Veteran.
  • Manage aggressive or disgruntled Veterans
  • Address Computer issues that take away form our time to work on our files.
  • Manage files of Veterans that are highly suicidal, substance abusers, involved in the criminal justice system, at risk of homelessness, in crisis because their families are breaking down, have unmanaged mental health symptoms such as delusions and psychosis ptsd, debilitating depression and anxiety etc…or, are dealing with chronic pain.
  • Complete Veteran’s emergency fund applications that may be assigned for a case managed client
  • Contact our clients for our 90 day check ins (the frequency of the contacts will increase depending on the complexity that is determined by the CMAT)
  • Document all contacts within 24 hours
  • Provide updates to VSTM about how we are moving along with file closures and CMATs

I may have missed some stuff but, this is the vast majority of it.  

As I am sure you are aware, everything in the department is a priority.  In my opinion, the only priority that I have is ensuring that the Veteran remains safe. 

The focus is no longer on the Veteran.