This case study originally appeared in the True Link Financial whitepaper: Trends and Innovations in the PSNT World.

“We had people with more complex needs than we could meet with our standard services, and we needed to find a cost-effective and efficient way to help them,” shared Haley Greer, Master Pooled Trust Director at The Arc of Texas. 

For PSNTs that seek to support beneficiaries beyond their core trust administration services, this challenge is quite common. While some organizations have built an in-house team of case managers to support their beneficiaries’ wellbeing, small teams and limited resources can make providing these services challenging. That’s where a creative, out-of-the-box solution is required. Case management (or “care management,” depending on the organization) is an area where many PSNTs are finding innovative ways to do more with less.

Combining an in-house specialist and local, on-the-ground case managers 

In the case of The Arc of Texas, the solution involved a combination of internal and external resources: a Benefits & Resource Specialist and a network of case managers across the state. 

Because Texas is such a large state, hiring full-time, in-house case managers did not make sense for The Arc’s distributed client base. 

“Being face-to-face with someone in their home is critical to helping us understand a beneficiary’s situation and needs. Working with local, on-the-ground resources has been an effective way for us to gain the context and details we need to better serve our clients,” said Greer.  

Building an effective program

The Arc of Texas has relied on this model to provide case management for more than three years. Paying for a full-time Benefits & Resource Specialist from their remainder fund keeps them from passing along this expense to their beneficiaries. Anyone who needs help with benefits is sent to this Specialist; she walks them through the process, helps them apply, and can help speed along approvals in times of crisis. In Texas, the waitlist for certain benefits can last more than a decade, so expediting these processes is critical for The Arc’s clients. 

The Arc of Texas has leveraged their network – companies they work with, people they meet at conferences, etc. – to find reliable case managers across the state. These individuals are often nurses or social workers who are matched to beneficiaries based on their experience and knowledge of the beneficiaries’ needs. The process of finding the right case manager for each beneficiary can be a matter of trial and error, and they may go through a few options before finding the right fit. 

When a trust coordinator or the Benefits & Resource Specialist deems case management is needed, they work with the network of case managers to contract directly with the beneficiary. Greer said, “Creating relationships with our beneficiaries helps us understand their needs better. When we find that a beneficiary is struggling with something in their life, we enlist the care manager to investigate the situation to determine if the beneficiary needs additional services. The policy is kept simple because each beneficiary’s situation is unique. We have had beneficiaries living in unstable or dangerous housing, beneficiaries who need help finding appropriate local services, beneficiaries who aren’t getting the help they need from the people who should be providing it, etc.”  

“There’s a shared responsibility between the beneficiary and our organization,” said Greer. The beneficiary has to give permission to contract with the case manager and sign certain releases, and both parties (the beneficiary and The Arc of Texas) sign an agreement for payment to be made to the provider from the trust. 

How case managers can change lives

The impact of case management on beneficiaries’ lives is most evident when organizations like The Arc of Texas share personal anecdotes. “We had a client Dana (name changed) who came to us after suffering a Traumatic Brain Injury,” Greer shared. “After working with her for two months, we noticed she was calling in a lot, often confused, and struggling to pay bills for food and housing.” 

Concerned about her wellbeing, The Arc of Texas worked with Dana to arrange for a case manager to visit her home. This helped uncover that she was living in unhealthy conditions, struggling to take care of herself, and in need of additional support. The local, experienced case manager took the time to build a relationship with Dana and gain a better understanding of her needs: what was triggering her episodes of confusion, why bills weren’t getting paid, and what was causing her stress. 

With The Arc of Texas, the case manager worked with Dana to:

• Allow someone into her apartment to help with cleaning;
• Find her a place to live closer to her friends;
• Get set up with GPS to help with navigation and avoid getting lost; 
• Pay bills directly from the trust and use a True Link Visa Card for some approved purchases; 
• Purchase a car so she can meet friends, run errands, etc. 

Today, her case manager remains available when Dana needs support but is called on less frequently than when they first started working together. As Greer detailed, “It’s remarkable to see how much Dana’s quality of life has improved over the last few years; I’m so glad we were able to connect her with the resources she needed.” 

A positive impact across the board 

This approach to case management has also helped The Arc’s coordinators to process disbursements more efficiently for all of their beneficiaries. “Before we implemented this system, clients with a variety of requests and needs would call our two coordinators for help. Responsible for processing disbursements for more than 2,000 beneficiaries, our coordinators found it difficult to handle these calls as they were completing their other critical responsibilities,” explained Greer. “This model of case management allows our team to focus on their key tasks while better serving our clients in a cost-effective way.”