Care Management Vignettes

If you are reading this blog for the first time or maybe you been here before, you may be wondering or still wondering what exactly Care Management is all about. Care Management is a service the lay or everyday person may not be familiar with. We even see professionals in the ‘senior industry’ unsure of all that we do. I thought it would be helpful to give you some specific examples, via the below vignettes, to better understand the full picture of our services. These are just a few examples of the amazing work our team does every day. Still have questions? Reach out to us at lifelinks.care or at 615/595-8929. 

Now, enjoy some heart-felt examples of the work we are honored to do… 

Assessing Safety and Exploring Wishes to Stay at Home 

Mrs. J was 99 years old, living in a small house across the back yard from her son in Nashville. She fell and broke her hip. After rehab, she went to live at a local assisted living. She was a very independent and although the assisted living was very nice, she wanted to go home. She was alert and oriented, for sure. Her son called us in to assess if that would be a feasible move. I did the assessment of her home and her functional capacity and concluded it would be okay for her to be at home, with some adjustments. We got her an emergency call system. Our nurse went out every few weeks to check on her and I went every week to do physical therapy with her. She loved the exercises and was quite faithful in doing some on her own. During those visits, along with the exercises and problem solving, we had wonderful discussions about the books she was reading or current events, and about how life was when she was a girl. After a year or so, we added some care givers for a few hours a day. Her son came by every morning and evening to check on her, and they supplied the evening meal. She was able to prepare her own breakfast, including brewed coffee and lunch. Mrs. J lived to be almost 104, happy at home. 

-Jo Singer, Care Manager & Physical Therapist

Assisting with Finding Purpose and Quality of Life for All

I had a client once who was in his 50s, he had Cerebral Palsy, was wheelchair bound, needed assistance with all activities of daily living and had always lived with his mother. She was his main caregiver and was in her 70s (that is difficult enough), but on top of that, she was suffering from and receiving treatments for her cancer. She was otherwise homebound and unable to participate in anything that gave her true enjoyment, socialization, or self-care. They had caregivers come and go and were unable to depend on anyone else. The mother was depressed and not nearly as strong as she once was due to age and illness. When I started working with them, they were on the brink of crisis. I researched appropriate home settings to present to the family. I assisted them with tours and introduced them to staff at group homes. Once they settled on a new home environment for the client, I was able to expedite the application and approval process, advocating for the client along the way and handling all communication with the agency that managed the group home. Within a few months the client was moved to his new home. He is now able to go to sports games (his favorite activity), go to concerts and enjoy all kinds of socialization opportunities. He attends a day program where he participates in art classes, engages in his interests and spends time with others. Both the client and his mother had a marked improvement on their quality of life and are doing great! 

-Jenn Stoops, Special Needs Care Manager & Advocate

Advocating for Our Client and Saving Them Money

LifeLinks was contacted by the family of an 82-year-old man that had been hospitalized for weakness, dehydration and confusion.   He had been in the hospital for three days, and the hospital was planning to discharge him immediately.  They were recommending skilled nursing care for rehabilitation, but the family was told that their father’s Medicare would not cover the cost of skilled care because he had not had a 3-night hospital stay. A 3-night hospitalization, among other criteria, is required by Medicare to pay for the cost of skilled nursing.  This client met the other criteria and in fact had been hospitalized for three nights.  However, the hospital refused to count the first night’s stay, saying he was in the Emergency Department over the first night and was not formally admitted until the next day.  The LifeLinks Care Manager met the family at the hospital before 9am on Saturday morning.  The Care Manager and family members reviewed the facts of the case and talked with the hospital discharge planner and the client’s hospital doctor.  The client’s son had paperwork that documented that his father was moved from the Emergency Department into a hospital room at 7PM on the first night of care.  Even with that information, the hospital would not budge on their decision that he had only been hospitalized for two nights.  After discussion with the family, the LifeLinks Care Manager advised the family to appeal the decision with Medicare.  The family notified the discharge planner that they wanted to appeal.  After about 30 minutes, the discharge planner told the family that they agreed that the client had been hospitalized for three nights. Medicare typically covers 100% of the patient’s skilled nursing care cost for the first 10 days of care (assuming other requirements are met).  LifeLinks advocacy in this situation allowed the client to be admitted into skilled nursing at no additional cost to him for 10 days, and for co-pay costs for subsequent days.  This saved the client over $2,500 in the first 10 days, and approximately $1,400 over the following two weeks (roughly $100 per day).  Although the family in this situation had some knowledge of Medicare guidelines, having a LifeLinks Care Manager with them to advocate on their father’s behalf allowed their father to get the care and Medicare benefits to which he was entitled.   

Terri Lawson, Care Manager & Advocate 

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