Stories from Case Managers in Honor of Case Management Week…

As a Rehab Nurse Case Manager my story spans 25 years of friendships and life’s lessons that grew from catastrophic injury.

Teenage life tragically devastated in a heartbeat, suddenly quadriplegic. I was privileged to work 1:1 with them, their families, their homes, their vehicles and, specialized equipment to restore their lives and futures. Now adults, these friends are married with families. They have professional careers as teachers, counselors, social workers. I watch them raise their children and give back to society with a joyful heart, hopeful that something I said or did helped them climb their mountain.

I’m overcome with awe and respect for them and their accomplishments. It is I who have learned life’s greatest lessons from them. I’m so honored to be a part of their lives and success.

Respectfully submitted,

Margo P.
CRRN, CCM, LNC

Stories from Case Managers in Honor of Case Management Week…

My name is Stacey I am a case manager, and have been in my position for approximately 10 months. I am new to case management and I have gained a wealth of case management knowledge. But I must say the most rewarding thing about my experiences is that I am able to maintain my compassion for being a RN and advocate for my patients. 

A most memorable moment as a case manager and a life lesson is one of a recent experience I had on my assigned unit. I had a patient with a specific managed insurance that normally, 98% of the time, denies and does not grant authorization for acute rehab. The patient was refferred to acute but did not meet the obvious criteria so I was told by the team that the patient should go to SAR because “her insurance won’t give authorization anyway.”

I met with the patient because the social worker stated the patient had some insurance concerns. I met with the patient and she really wanted to “bounce back” and receive acute rehab. She became very anxious when she was told that she would not get into acute rehab because of her insurance. I listened and heard her cry and went through her chart and found a qualifing factor: neurological defict that was a new onset event post op. I advocated and presented this to her insurance asked them to please consider this case.

That afternoon I received a call she was granted approval and authorization was given. I met with the patient again and informed her that she had been granted authorization for acute rehab and that she would be discharged there. She became tearful and gave me a big hug. She was thankful which made me feel like that bedside nurse I will always be in my heart. I learned that case managers play a significant part in the admission stay and discharge of patients. I learned that we are dependent on by many, number one: the patients. It was rewarding to put a smile on her face and play the role of patient advocate; as I feel a nurse should be.

Stacey

In many instances, discharge planning from an acute setting to home requires a collaborative effort among treating physicians, the hospital discharge planner, post discharge home care providers, the patient, and their caregiver. Individuals with complex medical conditions or ongoing needs are often referred to a case manager at their health plan as well.  Health plan case managers are held to the same standards for assessing, planning, facilitation and advocacy for their patients as are case managers in any other setting.  I would like to make a case for including the individual’s health plan case manager in the discharge planning process.   While the hospital DC planner assesses the individual’s needs post discharge and makes referrals and arrangements for post discharge care in the home setting and the home DME and home care agencies provide the actual care and services, the health plan case manager may be very familiar with the individual prior to their hospitalization.  This often puts the health plan case manager in a position to provide valuable insight into the individual’s needs, caregiver issues and other concerns.  Additionally, the health plan case manager is in a unique position to continue coordinating services across the continuum of care.  

As a director of case management at a health plan, my case managers are accountable to coordinate a discharge plan when one of their patients has been admitted.  However, the case managers are reporting an unsettling trend of not being included and therefore not involved in their patient’s discharge plan.  Increasingly, our patients are being discharged and the health plan case manager is not contacted, even after leaving messages at the hospital office of discharge planning.   I challenge case managers and discharge planners in hospital settings to be true advocates for their patients and involve health plan case managers in the discharge planning process, not just for “authorization” of payment but in true collaboration for ongoing care coordination post discharge.

Kimberly Babaie, RN, BSN, Certified Case Manager

Director of Care Management