Social Work Flashcards
What do medical social workers do?
- D/C plans
- Case mgmt
- Legal issues
- Pt’s rights/concerns
- Crisis intervention
- Disease education
- Support groups/therapy
- Outpt. settings (e.g. dialysis, free clinics, PCP settings)
Most seniors enroll in this insurance program at age 65
Medicare
Seniors often select what in addition to Medicare to cover costs (co-pays, deductibles)
Medicare supplement
Medicare Part A
Hospital insurance
Medicare Part B
Outpt services
Medicare Part C
Medicare HMO/replacement plans
Medicare Part D
Prescription coverage
What does medicare not cover?
Long-term NH care
What is the future of medicare?
More restrictions & changes keep happening
Medicaid is insurance for what populations?
- People >65
- Blind or disabled
- Under 19 + pregnant
- Relative or caregiver of a child
- Categories for families/disabled/NH/illegal aliens/dialysis pt.
- Asset and income
What does medicaid cover that medicare does not?
Long-term NH placement
Family care in MKE county
- Case mgmt
- Home services: shopping, cooking, cleaning, personal care worker
- Paid caregiver
- Contracts w/ NH, transport, home care agencies
- Income limits (T-19)
- Contracted agents provide case management
In MKE county who CANNOT get paid to be a caregiver
A spouse; a friend/relative CAN
Community care
- Case mgmt/social work
- Own MDs/RNs
- Transportation
- Day care
- In-home services
- Income requirements (T-19)
- Aim to keep client’s in the community
- Program expanded to include patients with disabilities
- Family care contract
Utilizing healthcare resources
- Shorter length of stays
- Medicare DRG system/building
- Uninsured & underinsured population
- Aging population
- Push to reduce costs & be efficient
- Repeat admission may not be covered
- Hospital does not get payment for “never” events (e.g. HAP, pressure ulcers)
- Difficult for seniors to move at quick pace of healthcare
- Tighter inpt criteria (i.e. hip replacement can be outpt in a bed status)
Observation status
- Medicare has strict guidelines on what meets inpt. hospital criteria
- Admission for weakness/placement alone is not acute care criteria
- Contact case mgmt/utilization with questions
- Need >2 days to be inpt. status
- SNF rehab is not covered
Social work triggers
- AODA/mental health problems
- Advanced age/alone/no support system
- Non-compliance
- Cognitive problems
- Economic & social problems
- Multiple medical problems
- Multiple hospital admissions/ER visits/911 calls
Long-term acute care is indicated for….
Pt. that require on-going complex medical tx
What are examples of complex medical tx that might require the pt. to be in long-term acute care?
- VAC/wound care/HBO
- IV ABX
- Tracheostomy care/vent
- Multi-system problems
- Needs are too complex to be managed at a lower level of care
It has become more difficult to get insurance to approve what kind of care?
Long-term acute care
What is inpt rehab?
- Pt. remain in the hospital and undergo rehabilitation
Inpt. rehab requires participation in at least __ hours of therapy
3
Inpt. rehab requires pt. to undergo at least __ types of therapies
2 (e.g. PT, OT, ST)
What is the goal of inpt. rehab?
D/C home
What is subacute rehab?
Short term rehab stay
What type of institution offers subacute rehab?
NH facilities
Subacute rehab consists of __ hours of therapy per day
2
What is an advantage of subacute rehab?
Medical tx are available (e.g. O2, labs, IVs, wound care)
Medicare coverage of subacute rehab
Days 1-20 @ 100%
Days 21-100 @ 80%
What are two examples of outpt therapy?
- PT/OT
2. Cardiac rehab
What type of insurance covers outpt. therapy?
Medicare + secondary insurance
*only certain diagnoses are covered, long-term care is not
Pt. must be doing what in both subacute & outpt. rehab?
Reaching goals
How do people pay for NH care?
Private pay
What are some advantages to nursing home care?
- 24 hrs nursing services
- Custodial care
- Specialized units for Alzheimer’s dementia
Services that assisted living/group homes usually offer
- Medication assistance
- Bathing/dressing/cleaning/transport
How do people pay for assisted living/group home care?
Private pay
Pts qualify for homecare if…..
They are homebound
Homecare services include:
- RN visit (medications/lab draws/BP/dressing changes)
- Aid visit (baths)
- PT/OT
- Social work
How do people pay for homecare?
Medicare covers it 100%
- Requires MD order
Who qualifies for hospice care?
Pt. with a life expectancy of less than 6 months
Hospice is changing from an active tx plan to
Comfort measures
What is the focus of hospice care?
QOL
What is palliative care?
The step in between treatment and comfort measures
Is palliative care more or less restrictive than hospice care?
Less (e.g dialysis is continued, not all meds are stopped)
Palliative care teams help pts…
- Discuss long-term plans
- Review overall medical condition and goals
Two types of hospice care
Home hospice & residential hospice
What does medicare cover in regards to home hospice care?
100% coverage
Home hospice….
- Does not provide 24 hrs
- Family/caregiver to be primary support
- Focus comfort
What is residential hospice care?
Small facilities that specialize in end of life care
What does medicare cover in regards to residential hospice care?
It covers treatment/medication costs only, private pay is required for room & board
What is the most restrictive type of care?
NH care
What hospital D/C care is NOT common?
Assisted living/group home
Why is D/C from hospital to assisted living/group home not common?
Pts are not independent enough to go directly into this type of care
What can we do to help pt. cope with their diagnosis?
Connect pt. with community agencies
Examples of community resources
- Support groups
- Education
- Case mgmt
- Assistance w/ federal applications (e.g. insurance, food stamps, home help)
- Population health
Barriers to compliance:
- Transportation
- Insurance costs
- Lack of family support
- AODA/mental health
- Case mgmt
- Lack of medical knowledge
- Language/cultural barriers
- Bad decisions/noncompliance
Psych meds in dementia pts….
- Take up to a month to work
- Often need multiple adjustments
What is the best management for behaviors?
Prevention!
Strategies to combat confusion?
- Keep pt up for all meals
- Keep shades open
- Stay awake during daytime hours
- Follow a routine
- Stay out of bed as much as possible
- Have family visit & support staff
- Consider activity boards/sitting in the hall
- Avoid middle of the night labs/tests
- Work w/ pt. (don’t force tx)
Goals of HCP as an advocate for elderly pt.
- Return pt. to prior functioning
- Preserve dignity
- Include them in decision making
- Take a holistic approach
It is important for an elderly pt. to do what before something serious happens
- Establish a POA
- Create their own advanced directive
Social work is often a member of the hospital _______ team
Bioethics
The bioethics team must consider
- POA issues
- Guardianship
- Available options & funding
- Quantity vs quality of life
- Should seniors be forced to follow medical rules vs. enjoying life?
Where do we report abuse/neglect?
Department of aging
Referrals to social work can help…
- Maintain better long term outcomes for pts.
- Increase compliance
- Make our job easier
- Let patients know you care
