When Every Provider Says No

A structured search can reveal capacity without reducing the safeguards or forcing the person to make a bad match.

When providers repeatedly refuse the participant, the participant and case manager may send each other back and forth in the same directories with a growing need.

The declines can be attributed to geography, shift length, timing, workforce skill, risk assumptions, and/or a mismatch between the referral and the actual request. If they all say “no”, they all seem to be the same issue, so the bit they can change is not visible.

Why this matters for case managers

It is in the moments between decisions, whether for a handover, a change of provider or when the provider's daily work practices show that the arrangement agreed is not yet viable, that the value is formed for the case manager. The best answer is a combination of the direction of the participant and a brief record with named responsibilities and a realistic review point. This helps to minimise unnecessary coordination friction and maintains the professional and provider accountability.

What better coordination looks like

A disciplined capacity search narrows the brief, documents why each person declined and looks for other legitimate options that could still work, but still maintains participant choice.

Diagnose the search

Group the declines by reason and determine the nature of the barrier, that is, is it a timing, location, capability, information or commercial viability issue.

Improve the brief

Communicate essential needs, flexible elements, desired outcomes, location, schedule and necessary competencies in clear language.

Broaden responsibly

Where appropriate to the person's plan, safeguards and preferences, make comparisons between registered and unregistered or independent options, with appropriate checks.

Make the change last

A change that is useful is specific enough to practise and small enough to review. Decide who will do the first thing; decide where and when the decision will be written down and when the person will be asked if this helped. Where the approach requires multiple services, make sure to discuss each of those services individually, not all during a meeting, and then decide on it separately rather than at the same time. Keep what works, change what doesn't and eliminate measures that are in place to achieve a momentary goal that has since passed.

Questions for the next review

What would the person's point of view on the diagnosis be?

Which part is assured and which part is still an assumption or a request?

What will be seen by the person and team to determine that this is effective?

Keep the boundary clear

Urgency is not a reason to weaken worker screening, consent, service agreements or risk controls. Case managers should be clear about the availability of each option and not commit to making something available without confirmation.

A practical example

The rural participant was given five no's for four hours a week. The barriers were identified as being with regard to travel and shift timing, not complexity. The schedule was combined and a suitable worker could take up the arrangement with the agreement of the participant.