Discharge Planning Advisor - Uninsured cases increase in number, complexity

We try to educate them’

Arranging care for uninsured and underinsured patients has become more complicated in the past four or five years, says Jennifer DeCamp, MSW, LSW, a social worker at Swedish Covenant Hospital in Chicago.

"It seems there are more patients who do not have insurance and more challenging cases of all ages," she adds. "It might be someone who is 64 and won’t get Medicare for a couple of months, or, as with a patient I talked with today, a working woman who has health care insurance that pays 10% of the cost of her medicine and nothing else."

In the latter case, DeCamp notes, the woman already has missed several days of work, can’t work for at least another week, but has to pay rent, utilities, and other expenses, not to mention most of the cost of her medication.

DeCamp says she gave the woman information on how to request help from the Salvation Army, and the Chicago Department of Human Services.

There are a number of patients who are in the country illegally, she says, and so don’t qualify for coverage under any of the state or federal programs. "We’ll see patients and treat them, but after discharge, if they need follow-up care, they usually get it at the public health hospital."

She also deals with foreign patients who become ill while visiting the United States, DeCamp notes, as was the case with a recent stroke victim whose care became extremely problematic.

"The patient, who is in his 40s or 50s, needed a hospital bed, G-tube feeding, and a special mattress on the bed to prevent skin breakdown," she explains. "In cases like that, we work a lot with durable medical equipment [DME] companies. They are able to get us some breaks when people are so low-income."

If the patient had been living and working in this country, he would have qualified for public aid, DeCamp notes. Although he had been visiting family members here, they were unable or unwilling to take him home after his hospital stay, she points out. "They said they couldn’t afford it."

That patient, she says, stayed in the hospital far longer than his medical condition warranted, simply because there was nowhere else for him to go.

Getting the family involved

DeCamp says she has noticed that in many cases there seems to be a lack of any feeling of family obligation toward a patient who needs ongoing care. "It is the family’s responsibility to care for their loved one," she says. "That’s what people miss out on. If someone gets really sick, they need to step up and take care of them."

"We have a lot of nursing homes in this country, but if you don’t have Medicare or public aid, they are not an option," DeCamp adds. "The only other option is to go home."

With that in mind, she adds, Swedish Covenant tries to give as much information as possible to patient and family. "I try to educate, to say, Here’s what you’re up against, here’s what you can do, and here are tools to help you do it.’"

Exploring free or low-cost care options can take a lot of research and time, DeCamp continues, so in most cases social workers provide telephone numbers and addresses for resources, such as the city or state Department of Human Services or the Salvation Army, which may provide help with emergency housing, clothing, food, and medication.

The American Cancer Society has a used-equipment program, as well as other resources for those who need financial help, and the Alzheimer’s Association has a family relief program, adds DeCamp. "Depending on the diagnosis, you can go to one of those associations."

"We have a patient right now who is going to turn 65 in a few months and has very bad wounds, is on intravenous antibiotics, and doesn’t have insurance," she says.

"He is in that little pocket where — if he doesn’t work and can’t pay for his own care — we can’t send a home health nurse. We will have to teach him how to do dressing changes and care for the wounds, make sure they’re healing." DeCamp points out.

The patient’s medicine will have to be taken by mouth, she adds, and if he continues to need IV antibiotics, he will have to stay in the hospital.

"There is also a company that provides specialized wound treatment equipment that has a benevolence program," DeCamp notes. "It takes a lot of paperwork and contact with the family."

Discounts also can be obtained from DME companies, she adds, and various agencies maintain DME lending closets. If the patient is terminally ill, hospice organizations are good sources of help for the uninsured, providing such things as pain medication, a hospital bed, oxygen or nursing support, DeCamp explains.

While Swedish Covenant provides a large amount of free care each year, there is a focus, she adds, on encouraging the patient to take responsibility for his or her own care once he or she is discharged.

"We’re getting them started, but for follow-up, they need to take over," DeCamp notes. "We try very, very hard to prepare everybody not to anticipate that once they go home, they can depend on us to make all the necessary calls."

"We try to educate them to get in touch with the appropriate agencies on their own," she adds, "so if something breaks down, or they need help, they have more control."

[For more information, contact:

Jennifer DeCamp, MSW, LSW, Social Worker, Swedish Covenant Hospital, Chicago. Phone: (773) 878-8200, ext. 5274. E-mail: jdecamp@schosp.org.]