Reform Proposal 3

According to the Wisconsin Board on Aging and Long Term Care, long term care consumers have the right to be…

…fully informed of their rights, services available and all charges prior to admission to a facility or enrollment into a program.

…given advance notice of transfer, discharge, disenrollment, termination, or charges in services (1).

Case management can be defined as “the process of matching client needs with available services that are likely to best address those needs” (4). I believe the rights outlined above affirm the importance of “case management.” The purpose of case management is to assess the special needs of older adults, to prepare a care plan to address those needs, to specify services that are most appropriate, to determine eligibility for services, to make referrals and coordinate delivery of care, to arrange for financing, to ensure that clients are receiving services, and reevaluate needs as circumstances change over time (4).

I propose that hospitals be more active in their patient’s care beyond the hospital setting into the long term care location. They should make a commitment to their patient in seeing them through all their care even after discharge to a long term care facility. Under this approach, hospital-based case managers would identify clients, assess their needs, develop care plans, coordinate service delivery, and monitor results (2). This kind of care would be an extension of the hospitals services since the care is given after the patient has been discharged.

Policy makers have been urging hospitals to be more active in their patients care beyond the hospital walls. This is because the hospitals have been failing to meet the post discharge needs of their elderly patients with chronic health problems (2).

The federal government should act on this and make an attempt to have case management a regular part of the care of the hospital to ensure continuity of service. A case manager should be assigned to the patient and assess the care from acute care to the long term care facility (5). A case manager could be a nurse or social worker hired to see through their case from start to finish. For this to work, the hospital should run the case manager program in whatever way they see fit as long as they follow the guidelines from the government. The social worker or nurse would be assigned to each patient based on need. They will be able to monitor and coordinate the services more closely than an independent case manager (4).

The ultimate goal of case management is to bridge the gap between the acute care received at the hospital and the long term care (2). Case management assists in decreasing nursing home care through increased supportive services (3). If case management is available to the patient, it is found to be extremely beneficial in preventing unnecessary costs on the patient and their family. With this new policy, readmission of Medicare patients to the hospitals could be reduced and that would improve hospital profit margins. Since the quality of care would increase with case management, more patients might be attracted to this specific hospital and profits would increase. The care provided would be more appealing than competing hospitals without that service.

Case management protects the patient by allowing them to receive the care they need through a needs assessment by the case manager. The quality of care for others in the facility increases since these specialists are more readily available for patients who actually need them.

Since long-term care services, eligibility requirements, and financing can be overwhelming for the patient and the family it is important for case management to be there to support these issues. Many patients or older individuals live far from their children, so these services are comforting to the family as a whole (4). The patient will have increased access to the care they need because they will be receiving a direct assessment of their needs from their case manager.

A potential problem to this case management is that the patients might not find it necessary to spend the time with their case manager. The problem might arise with cooperation from the patient. The multiple consultations and time commitment with case managers could be a burden.

The funding for the case managers could be an issue. Depending on the type of patients referred to the case manager, the cost could come from within the hospital or vary based on insurance coverage.

1. Board on aging and long term care (n.d.). History. Retrieved February 16, 2011, from http://longtermcare.wi.gov/subcategory.asp?linksubcatid=3001&linkcatid=1953&linkid=1014&locid=123

2. Christianson, J., Warrick, L, Netting, F., Williams, F., Read, W. et al. Hospital case management: bridging acute and long-term care Health Affairs, 10, no.2 (1991):173-184

3. Cress, Cathy. (2007). Handbook of geriatric care management. Jones & Bartlett Publishers: Sudbury, MA.

4. Shi, L., & Singh, D. A. (2008). Delivering health care in America: A systems approach (4thed.). Boston: Jones and Bartlett.

5. Wilson, Margaret. (2011). Case management in long-term care: challenges, changes, and opportunities. The CBS Interactive Business Network. Retrieved March 2011, from http://findarticles.com/p/articles/mi_m0FSS/is_n1_v6/ai_n18607261/?tag=content;col1.