Geriatric case manager Nancy Downey has been a nurse for 46 years and has worked with the elderly for most of her career. At Generation Solutions, a home health agency in Lynchburg, Virginia, she started a care management program to help seniors with everything from getting to doctor’s appointments to facilitating home repairs.

Downey launched the program in 2015 after visiting a patient who lived alone and had no family nearby. She knew the patient would benefit from someone to coordinate care and serve as a liaison to family members.

“I’m an advocate first,” she says. “Most of my clients don’t have family nearby, so I’m a surrogate for them.”

Generation Solutions’ care management team now includes four case managers and 15 clients. Downey hopes to add a social worker to the team next year.

“We want to help people stay in their homes for as long as that’s the best option for them,” she says. “This is what’s happening in home health and we want to be at the forefront. The need is out there.”

Downey has learned that clear communication – with doctors, patients and their families – is key. Prior to the first physician visit with a new client, she prepares a memo for the doctor recapping the patient’s health and past medical history. At follow-up visits, she provides an update for the doctor to review prior to the appointment.

“It’s a useful tool and physicians say they appreciate having one of us in the room,” she says. “Our clients might not tell the doctor everything for fear of being taking out of their home. But physicians need to have a complete assessment.”

She also knows that most of her patients welcome an opportunity to socialize, and that informs her approach.

“You can’t come in to their home and immediately point out 10 things that have to get fixed,” she says. “We work together to choose one priority to build up some confidence. I want to involve them in the process.”

Downey provides regular e-mail updates to families and includes everyone in health-related decisions or changes. “You have to have the family’s trust and input,” she says. “I’ve had family members tell me that since they can’t be here, they feel so much more comfortable that I’m here.”

Paul Tulane Patterson, CEO of Generation Solutions adds: “Nancy has been a nurse, manager and family to so many elderly clients and has truly given them the care management that has enabled them to live at home safely. She is an amazing person and professional.”


Case managers are often the unsung heroes in a patient’s recovery. In conjunction with National Case Management Week, we asked for nominations for outstanding case managers who deserve some extra recognition. We continue to share the stories of some of the case managers who have been nominated. Read More

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