It is important to know the scope of case managers in order to know how to utilize their services.
www.kathysconsulting.com
https://www.dhs.state.il.us/page.aspx?item=33612#:~:text=These%20services%20provide%20assessment%2C%20planning,assistance%20with%20transportation
https://cmsa.org/who-we-are/what-is-a-case-manager/
https://cmbodyofknowledge.com/content/introduction-case-management-body-knowledge
https://www.verywellhealth.com/what-does-a-case-manager-do-1738560
Welcome to knowledge for caregivers. My name is Kathy, the host of this podcast. I have been a geriatric nurse for the past 10 years, I am going to share with you the knowledge that I have learned helping seniors age in place. This is the same knowledge that I use to take care of my own age loved ones, I hope you can use this knowledge to help your own age loved ones age with dignity, and grace.
Welcome back, I got a call from a lady who was in town because her mother had had a stroke. And now she was in rehab. She didn't know what her next step was going to be because she was only here for a short time, and she was having to make decisions about her mother. The first thing I asked her was, “Do you have a case manager?” She goes, “yes, but this is what the case manager told me and I'm not sure if it's giving me good advice.”
I want to explain a little bit about what case managers are and why it's very important to know about them. Case managers are becoming more popular. As more people use them--doctors offices, home health, even insurance companies are beginning to use case managers. Many of these case managers are registered nurses, although there are some that are also social workers. The reason that they are beginning to use registered nurses is that we are beginning to shift in the United States from a health care system that only treated sick people to try to keep people well and help them manage chronic conditions. The goal is to begin to move registered nurses from the hospital where we're caring for sick people back into the community where we're helping people manage chronic conditions to avoid the hospital.
There are different case managers depending on where they are working. So I'll start off with the hospital case managers, when a person comes into the hospital, and especially if they're an older person, and it looks like maybe they will have trouble going home and taking care of themselves, they will be assigned a case manager. If you go to the hospital, say you're younger, you have a broken leg, you know you're going to go home and take care of yourself, you will not have a case manager. When older people go to the hospital, it can be something minor, like just a bladder infection. But after being in bed for a couple of days, maybe having to go a couple of days without eating while they run test, that older person all of a sudden can become very weak and lose their ability to walk, then it's necessary for them to go to another place after the hospital.
The case manager in the hospital basically has two functions. One function is to make sure that the person who comes into the hospital the patient has a diagnosis that is approved to be in the hospital, hospitals can't operate for free, they do need to be paid. So they're going to make sure that a person who comes in say has pneumonia has the right code assigned to them for the insurance and that they're getting the type of care that anybody with pneumonia would get. Then their second job is to determine where this person is going to go after their hospital stay. The goal is to get people out of the hospital where they have intensive therapy into another location. So the hospital case manager, his job is to decide the next location. If they cannot return home, then they will go to what is called rehab or skilled nursing facility. A skilled nursing facility many times shares a building with those who are also in there for nursing home care or long term care. That's why sometimes people get them confused. And then they'll say well, no, I don't want my loved one to go there. I want to bring them home. A skilled nursing or rehab facilities whole goal is to get them strong enough to where they can come back home. So basically, they're medically stable, but they're just weak and maybe they still need a nurse to oversee them taking some antibiotics, and then physical therapy, occupational therapy and speech therapy. We'll work with them in rehab to also get stronger.
So when you're in the hospital, you're assigned a case manager. You will probably speak to that case manager every day because hospital stays are meant to be short, two to five days at the most unless you're of course very sick and need intensive medical treatment. Then when you go to rehab you will be assigned another Case Manager. So sometimes it gets really confusing. I had a family member who went to rehab but then got sick had to go back to the hospital. They did this several times. Then when I was talking to their children, she said it was so frustrating because every time they went to the hospital, we had a new case manager. So that can happen if you're on a different floor or you have a different diagnosis.
When you go to rehab, you won't meet every day with the case managers. Case managers, nurses, doctors, therapists usually meet once a week, they will take everyone's chart and they will analyze how everyone is doing. And at that point, they will be talking about discharge. I want to tell people right now, the biggest mistake I've seen people make is when their loved one says I am not going to rehab I want to be brought home, and they are not ready to come home. And the spouse especially who is also probably older and frail, is then required to provide 24 hour care for this loved one who is probably weak, who probably requires a lot of lifting and pulling. They are usually overwhelmed. And they usually realize, hey, I made a mistake. But at this point, it's hard to turn around. What I tell people is if they cannot walk around and get around the way they were before they go to the hospital, you need to tell your case manager, I cannot take care of them at home like this, we need to get them to a higher functioning level. That will then trigger for them to go to rehab, when they go to rehab. Keep track of what they're working on and what goals you want. They may not be able to get your loved one to the level that they were before. And then you can make other decisions. But that's why it's important to keep in touch with the case manager to see how your loved one is getting along.
Then after you go to the hospital, if you get far enough along to where you can go home, you will be sent home in United States with something called Home Health. Home health is nurses and therapists will come into the home and help you in that transition at home. For instance, you may have been able to take a shower, at the bathroom at the facility. But then when you get home, you have a whole different shower setup. So the therapist will work with you on getting your home safe, getting around your home safely, and how to do things like getting dressed, going to the bathroom, taking a shower in your own home. These therapists do not take care of you. So when you go home, if you can't take care of yourself, it is very important that somebody is there to help take care of you whether you hire somebody or where their family comes in, because their job is just to continue to work with your therapy to get you adjusted to being at home. In the United States, that therapy is ordered for like 30 days or 60 days, but you must show that you are progressing. So if someone comes home and they refuse to cooperate with physical therapy and do their exercises and try to get stronger, at some point they will discharge them.
Again, this is a time to also keep in touch with the case manager they will come out with you. And they will say what are your goals. So are your goals to get them to be able to shower by themselves to go to the bathroom by themselves to be able to take their own medications. That is kind of the gist of how things move from the hospital to rehab to home. You can also get home health if you go to a assisted living or memory care, because those are not intensive places to live like nursing home or long term care facilities. Even if your place of living is an assisted living, you can still go the hospital, go to rehab and then come back to assisted living and home health will come out to work with you. If it is determined that you cannot live that you have a diagnosis in which you will die within six months, then they will recommend that you go on hospice.
What are some other ways of case managers. So you can hire case managers in Oklahoma City there are several companies that work as case managers and they help manage your doctor visits, your medications, your billing, who's going to take care of you those different types of things. Insurance companies are also beginning to bring on case managers, they usually bring them on to help individuals with chronic conditions. For instance, if you have something like diabetes, or you have a lung disease or you have a heart disease, those are conditions that now need to be managed at home and if you manage them successfully, you can probably avoid going to the hospital. So many of these case managers will call you up. They will say Hey, are you checking your blood pressure? Are you checking your blood sugar? Are you weighing yourself every day? How are you breathing? They'll ask all kinds of questions to determine if you're managing your disease well at home, they do that now by calling you on the phone. So it's very important to keep in touch with these people, they can be a wealth of information.
One of the things that happens in my line of work is many of my clients, they just want to talk to a medical person. It's not something where you go to the doctor and say, Hey, I have a sore throat, what do I do, it's more, I'm having trouble getting to the bathroom, or I'm having trouble taking a shower, or I'm having trouble getting dressed. It's things that they know that a doctor isn't really qualified for, because it's not really a medical condition. And that is when it is helpful to get a case manager on your side. Because so many people just have questions. So look around and find out if even in the community, getting a case manager will be helpful. I'm hoping that the United States Health System will begin to move where many doctors will begin to hire case managers so that people can call them up and just talk to them about these issues that don't really involve having to go to a doctor, getting a diagnosis of a medical condition, but just trying to figure out as I get older and I'm managing chronic conditions, how do I do that successfully. Thank you for listening and going on this caregiving journey with me.
If you like the podcast, share it. See the show notes for more information. If you want to see resources or set up consultation services for your unique family needs, go to www dot Cathy's consulting.com That is www.ka TAYSCO in su lting.com. Remember, all content is for informational purposes and not meant to replace consultation with a medical professional