America Living With AIDS

Caring for People

seropositivity all the way through the
care and support needed in the terminal phases of illness.
Primary care practitioners and
medical specialists can provide only
some of the services needed by people
living with HIV disease. Nurses, psychologists, home health care workers,
nutritionists, and other health care
and mental health care workers are
equally essential in ensuring the availability of a continuum of care. Also
crucial are social workers, case managers, patient advocates, and others
who help people living with HIV disease find jobs, food, and housing--
services that must be available if medical care is to be effective. In some
instances, especially where discrimination based on HIV status is involved,
people with HIV disease will need
legal advice to gain access to basic
health and social services and to ensure
that their wishes are carried out regarding decisions about terminal care. It is
also critical that the patient/provider
relationship be based upon mutual
respect and cooperation. The patient
must feel comfortable that providers
are approachable about the full range
of care and treatment options. For
example, more and more individuals
are seeking advice about or are using
nontraditional and alternative therapies, usually in conjunction with conventional medical treatments. It is
important to establish a relationship in
which both the patient and provider
are comfortable asking questions.

Throughout its tenure the Commission has heard testimony on local
efforts to better coordinate care under
the rubric of "case management." The

goal of case management
is to guide patients efficiently and humanely
through the health and
social services labyrinths.
Case managers serve
simultaneously as gatekeepers, advocates, educators, diagnosticians, brokers, and caregivers. They
are responsible for far
more than coordinating
medical care services;
they often help find housing, help connect people
with specific entitlement
programs and other
sources of income support and payment for
health care, and link people with HIV disease with
programs of volunteer
support.
A variety of case management styles has emerged
to meet the needs of people with HIV disease.
Depending upon the
model involved, a case
manager may be a nurse, a

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social worker, or a primary care physician. In some instances, case management is funded by government, is hospital based, and is linked primarily to
discharge planning. Other case management programs are more community based and follow individuals both
in and out of the hospital. In some
states case management is provided by

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