Case Management Chapter 5: Transitional Planning Flashcards
Discharge planning
part of transitional planning that focuses on discharging patients from an inpatient hospital setting to another facility or home
Transitions of care
process of moving patients from one level of care to another, usually from most to least complex; however, depending on the patient’s health condition and needed treatment/services, the transition may occur in the other direction-from least to most
Levels of care
The setting a patient is in or the amount of care he/she is receiving, definition/criteria varies from facility to facility 1. Acute care-acute care hospitals, inpatient acute rehab hospitals, all services within these hospitals(ER) 2. Postacute care-SNFs, Hospice, rehab units, home health agencies, specialty pharmacy providers
Transitional points
- transfer of responsibility for care from one healthcare provider to another (ex: PCP to specialist) 2. change in the environment of care within a healthcare facility(ex: ICU to inpatient floor) 3. Change in environment of care from one facility to another 4. Change in the plan of care (ex: adding a medication, adding/discontinuing a therapy) 5. Change in the payer or health plan (ex: private insurer to Medicare). It is important for CM to understand what constitutes acute care, custodial care, skilled nursing care, etc. so that patient can be matched appropriately to each level of care.
Custodial care
primarily for the purpose of helping patients with their personal cares and ADLs; setting: home, assisted living center, group home
Intermediate care
: patient who requires moderate assitance with ADLs and restorative nursing supervision for some activities; setting: intermediate care nursing home (no 24 hour nursing care)
Skilled nursing
present need for a skilled licensed professional provided on a daily basis and must take place at the SNF level for reasons of patient safety and economy: nursing home, skilled nursing facility
Long-term care
care targeted at persons with functional disabilities that may present as a physical or mental problem; setting: nursing home, foster homes, day care center
Acute care
inpatient hospital care; setting: hospital, inpatient acute rehab facility: requires that the patient can tolerate 3 hours of rehab services daily and can follow 2-3 step commands, transitional hospitals: acute care hospitals for medically stable patients with long rehab needs and care that is too complex for SNFs to handle
Hospice
philosophy is that terminally ill patients should be allowed to maintain their final days of life comfortably, with respect and dignity. Setting: hospice facility, patient’s home, inpatient, nursing home
Palliative care
interdisciplinary approach to care delivery with the main focus of relief of suffering and improvement in the patient’s quality of life; settings: all care settings(hospital, SNF, outpatient clinic, assisted living)
Transitional planning
dynamic, interactive, collaborative, and interdisciplinary process of assessment and evaluation of the healthcare needs of patients and their families or caregivers during or after a phase/episode of illness-process ensures that services are provided at the appropriate level of care-right time, right amount, right provider, right setting
Utilization Management
management and evaluation of medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities while staying in the boundaries of the health care plan. UM and transitional planning go hand in hand-part of both goals are to get the patient to the right service/appropriate level of care. CM has to be aware of health care benefits and what is possible and not possible for patients. It is important to know up front the limitations and work from there, rather than come up with a plan and have to throw it all away because it is not covered.
