The Trauma Patient Social Work And Case Management Perspectives


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I presented this at the Trauma Symposium in November 2008 to introduce a different perspective on the role of the social worker on the trauma team.

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The Trauma Patient Social Work And Case Management Perspectives

  1. 1. The Trauma Patient: Social Work & Case Management Perspectives By: Jennifer Ayers, LMSW Trauma Social Worker
  2. 2. Discharge Planning  Assessment  Home Situation  Social Support  Physical Capabilities before & after injury  Financial Resources  Coordinate with the ETS team  Inpatient consults (i.e. PT/OT, Rehab, Speech, etc)  Potential Discharge Referrals and/or Consults  Discharge needs  Home  Home with Home Healthcare  Inpatient Rehab  Skilled Nursing Facility  Long Term Acute Care Hospital (LTACH)
  3. 3. How do we decide where a patient goes at discharge?  Levels of Care  Home: No needs, patient can care for self  Home with Home Health (HHC): Patient can go home, but needs skilled personnel to provide limited support  Inpatient Rehab: Patient has a diagnosis that qualifies for rehab, patient has to be able to do 3 hours of rehab per day and is rehab-able  Skilled Nursing Facility (SNF): Patient requires 24 hour care, does not qualify for inpatient rehab, and has a skilled need  Long Term Acute Care Hospital (LTACH): Patient will need an extended acute care stay, he or she has multiple medical needs, and is rehab-able
  4. 4. Insurance Issues in Discharge Planning  Medicare  SNF: 3 midnights as an inpatient prior to transfer to SNF & have a skilled need (PT/OT, wound care, IV antibiotics, TPN, tube feedings)  LTACH: Estimated Length of Stay (ELOS) is at least 18 days & has multiple medical problems (tube feeds, wound care, IV antibiotics, PT/OT, trach/vent care)  HHC: Patient must be homebound to receive HHC  Medicaid  Completed Title 19 form for equipment by a Staff Physician  Limited Medicaid beds available for placement  Limited HHC benefits  Nursing Home Medicaid for SNF placement  Commercial Insurance  Prior authorization for placement in most cases  In-Network Facilities and Services (insurance Case Manager)
  5. 5. How much does it cost?  Inpatient Acute Care  Home Health Care  Floor Bed: $1200/day  $155/visit  Surgical Bed: $1500/day  Equipment  ICU Bed: $1800/day  Walker  Long Term Acute Care  Bedside Commode  Same as an ICU Bed:  Crutches $1800  Medication  Inpatient Rehab  Vicodin  Skilled Nursing Facility  Norco  Depends on the Level of  Cipro Care required  Flagyl  $120 to $600/day  Lovenox
  6. 6. Unfunded Patients: Discharge Planning Issues Get creative!  Placement: Santa Fe SNF or Inpatient Rehab to keep the patient in the S&W system if possible, try for charity beds at outside rehab facilities, if there are no beds available, then an indigent contract can be drawn for SNF placement at local nursing homes authorized by the Director of Case Management  Medication Assistance: Financial Assessment, Co-pay is required for assistance  Home Health Care Assistance: 50/50 split with S&W HHC if the pt is in the service area; if pt is out of the area, try an outside agency that can provide charity care  Equipment Assistance: Check with family members to see if they have old equipment, financial assessment for Case Management assistance (a co-pay is required)  Wound Vac: KCI charity program--pt has to meet criteria for assistance and proper documentation must be sent