Case Management

Sneak Peek: Respect patient choice; ensure education on appropriate discharge options

Case Management Weekly, February 22, 2012

By Wei Deborah Lee, RN, MSN, case manager

Ms. W is admitted to a Kindred long-term acute care hospital with diagnoses of thrombosis of the superior vena cava and osteomyelitis of the spine. She is a bariatric patient (360 pounds) and is receiving hemodialysis. She needs maximum assistance to get up from her bed. She also has severe back pain requiring management with intravenous Dilaudid® every four hours.

Ms. W has a boyfriend and a 12-year-old daughter at home. She is depressed due to her three-month hospitalization and insists she will be going home upon discharge.

Despite the case manager spending copious amounts of time educating Ms. W on Medicare acute days, her risk of going home, compliance, and the need for safe continuing care at a SNF, the patient insists on either staying in the hospital for more physical therapy or going home. Ms. W’s physician and physical therapists agree she should not go home, even if she receives home health services.

This item is adapted from an article which originally appeared in the February, 2012 issue of the eight-page, HCPro, Inc. newsletter, Case Management Monthly.

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