Ensure patients, families informed after discharge

Offer all options, including private duty services

When you are developing a post-discharge care plan for patients who will need some assistance at home, make sure the patient and family understand what is required of them and that they are aware of all their options, including paying for private home care services.

Patients must be able to care for themselves or have a primary caregiver in order to be considered appropriate for home health services or hospice services paid for by any payer, whether it's Medicare, Medicaid, or commercial insurance, points out Elizabeth Hogue, Esq., a Washington DC-based attorney specializing in health care issues.

Case managers should make it clear when the patient will need care between visits from the professional staff and be as specific as possible about the role of the primary caregiver and the tasks that they will be expected to perform, and the time frame in which the patient is likely to need care.

"Potential caregivers may be reluctant to care for incontinent patients, to dress wounds, and to give injections. If this is the type of care that is needed, case managers should clearly explain these activities to potential caregivers," she says.

It is helpful if case managers help potential primary caregivers realistically evaluate whether they can provide all of the care the patient will need and realistically evaluate if they can perform the tasks, she adds. For instance, if a patient needs assistance with multiple transfers, a caregiver with back problems may not be appropriate for the role.

"Patients' family members or others may be willing to fulfill the caregiving role on a voluntary basis. If not, case managers should explore the option of using paid primary caregivers to meet the patient's needs in between visits from professional staff," she says.

Home health agencies, private duty agencies, and hospice agencies may be able to provide private duty services including sitters, live-in staff, and health care aides, Hogue says.

Offer the option to pay for private duty home care services to all patients who can benefit from the services, Hogue suggests.

Even patients who can care for themselves or who have volunteer caregivers may welcome additional assistance, she points out.

"Discharge planners or case managers may be reluctant to offer these services to patients and their families because of the cost. They may erroneously conclude that patients and their families cannot afford these services," she says.

Don't jump to conclusions about what patients and families can or cannot afford, she says.

"Offering private duty home care services is consistent with legal and ethical requirements that govern the practice of case management," she says.

From a legal point of view, hospital case managers must comply with Medicare's Conditions of Participation, which require discharge planners or case managers to develop appropriate discharge plans, if necessary, for all patients.

"Development of appropriate discharge plans undoubtedly includes private duty home care services for patients who may benefit from them," she says.

The Case Management Society of America's national standards of care for case managers make it clear that case managers have a duty to advocate on behalf of their patients, Hogue points out.

"As advocates for patients, case managers have an obligation to make sure that patients understand all of the options available to them, including the option to pay for private duty home care services, she says.

Ethical principles require case managers to provide information to patients so they can make informed choices, she adds.

"Patients cannot make choices about the care they wish to receive unless they have information about all services available, including private duty services. Consequently, case managers have legal and ethical obligations to make sure that all patients have information about private duty home care services," she says.