BY , RN, MSN, ACM-RN, RN-BC
The role of a case manager has changed as a result of the COVID-19 pandemic. Effectively managing a patient caseload in inpatient rehab isn’t easy under our normal conditions. Case managers are accustomed to “managing during a crisis.” They often have patients who have suffered traumatic events or have challenging living or social/family situations, but when the “crisis” also includes a global pandemic, that adds multiple layers of complexity to the already demanding role.
OVERCOMING PANDEMIC-RELATED CHALLENGES
The pandemic has brought many challenges to case management, and with those challenges, many opportunities for trying new, inventive ways to meet the needs of patients. First, case managers had to learn how COVID-19 is spread and how to prevent its transmission. The primary means of controlling the spread are socially based and rely on a person changing or adopting new behaviors like wearing face coverings, practicing good hand hygiene, and self-monitoring symptoms. Case managers have had to expand their coaching skills to help patients and families understand and adopt these new behaviors.
Limited physical distancing during the pandemic has made telehealth practices become part of mainstream healthcare. Social distancing has separated patients from their families at a time when that connection is so vital. To bridge that gap, case managers have had to learn more about telehealth service platforms, remote communication applications, and even different devices so they can help patients and families with telehealth visits and help them communicate with their loved ones while in the hospital.
As we all know, other industries have been impacted by the pandemic like transportation, food availability, financial institutions, and religious centers, for example. Case managers have to research unique ways to meet patients’ needs related to these types of services.
Case managers have to stay abreast of state, regional, and national changes and maintain up-to-date knowledge of modifications to Medicare conditions of participation, enacted waivers, changes to payer requirements, and process changes made by home health or medical equipment suppliers in response to COVID-19.
IMPACT ON THE DISCHARGE PLANNING PROCESS
Discharging patients back to their home has always been the focus of inpatient rehabilitation. During the pandemic, it has become even more of a priority. Returning a patient home at discharge and not transferring them to another facility, like a nursing home, helps to reduce the risk of COVID-19 transmission in the community. The pandemic has increased the need to individualize patient discharge plans to their unique situation, and changes that have occurred in their environment or within their support systems like the closure of schools and certain businesses, for instance.
DISCHARGE CONSIDERATIONS
Here are some topics to take into consideration when planning a discharge during the pandemic:
- Ask the discharging physician to determine if quarantine or isolation is needed after discharge. If so, inquire as to what level of PPE the patient or caregivers will require and for how long.
- Assess if the patient can procure the necessary PPE. If not, have a plan to assist with this. Consider providing limited quantities if needed.
- Start coordinating home care needs related to DME and home healthcare as soon as possible.
- Incorporate basic infection control guidelines in discharge education.
- Other education-related topics to consider are:
- Donning and doffing relevant PPE
- Self-monitoring of COVID-19 symptoms and who to call if symptoms develop
- Provide patient with information from the local Department of Public Health and any home isolation instructions
- Anticipate delays with SNF transfers or long-term care placements and possibly dialysis referrals.
- Be prepared for some post-acute care providers to require COVID testing prior to admission.
- Discuss with discharging physicians a plan to provide adequate quantities of medication on discharge prescriptions to allow for possible delays in securing a PCP appointment or for necessary quarantine/isolation time.
- Investigate the availability of telehealth appointments for follow-up. If this is an option, assist the patient and caregiver with getting set up for these appointments and ensure they have the necessary tools or equipment needed.
- Assess patient and family ability to procure food during the quarantine period (1-2 weeks) and assist as needed:
- Explore grocery delivery options with the patient
- Consult Meals on Wheels – confirm availability
THE HARD CASES GET HARDER
Challenging discharge situations have become even more of a challenge during the pandemic. Case managers are in closer communication with state agencies to resolve transition issues for special populations like homeless patients who may have limited or no access to shelters, patients requiring guardianships to be pursued with the court system, or those patients awaiting Medicaid assistance.
In many ways, the pandemic has required case managers to become better communicators and better at forming partnerships and collaborating. These are just a few of the pandemic-related dynamics that are making the role of the case manager more important than ever. It is becoming very apparent these days that case managers truly are the key to coordinated care across the healthcare continuum.
A FEW BITS OF ADVICE
Case managers are often viewed as the person who always has a plan, but this is uncharted territory and things are changing rapidly with the pandemic. Case managers are learning how to navigate these changes successfully together and create “the plan” as they go. There are many new variables impacting transition planning now; it is easy to get overwhelmed and feel like things are out of your control. My advice is to put your focus on the things you can directly impact. Be flexible. Keep learning. Continue to be a relentless patient advocate, ask a lot of questions, and be sure to involve others in decision making. Keep communicating and working together collaboratively.
, RN, MSN, ACM-RN, RN-BC, is the national director of case management for Birmingham, Alabama-based Encompass Health, one of the nation’s largest providers of integrated healthcare services, offering inpatient rehabilitation, home health, and hospice services in 39 states and Puerto Rico. She has been a registered nurse for nearly 30 years and has well-rounded healthcare experience consisting of inpatient critical care, outpatient care, the physician practice setting, clinical informatics, legal nurse consulting, and managed care. Dina has held many leadership roles in her career including managing inpatient and outpatient cardiac care services, leading multiple facets of case management for a large Medicare Advantage plan, and now overseeing case management services for the Encompass Health network of more than 135 inpatient rehabilitation hospitals. Dina holds a master’s degree in nursing in addition to two case management certifications.
