Attention all discharge planners. I need an honest opinion

The hospital DCP not only deals with the annoying pt and family, but at my hospital, all the pts think they are "entitled" to free things or services covered by insurance. This is rarely the case. I can not change the fact that your copay for IV infusion is 100 dollars eery time a nurser comes out, I know you need it, but you have the insurance that has a poor DME benefit. I can't arrange for a ride home for you just because your family doesn't feel like coming to get you. You state you need a commode, a shower chair, a wheelchair,wheelchairs are near impossible to get, commodes are only to be used if there is a flight of steps that the pt must use in order to get to the bathroom. Shower chairs are not a covered expense in most DME benefits.
The best of the most annoying is the large population of uninsured, who need home care supplies, nursing but have no insurance and need to have medications filled, free clinic advice, DME providers do not give a pt on medicatiod application oxygen.
The doctors make discharge plans regardless of the pts insurance. Ie, a doc wants a pt to go home on lovenox, you call the pharmacy and the copay is $800.00, so now pt can't afford it, so plan changes, you wasted 2 hours finding out if the pt has coverage for it and finnd out they do but can't afford it. Or try getting free medications for an illegal ailian. Good luck, so much work.You set up IV abx fax scripts and right before they leave, they now need po abx instead. Call the infusion co back explain the plan changed. My very favorite job is setting up home O2 Bipap and there is not adequate documentation in the chart, need a hospital bed ., the discharge planner must have one in her back pocket since no one thinks that you need to have documentation for it.
Love the calls from the pt 3 days post discharge saying, I need a commode, I didn't get all my perscriptions, my pharmacy won't fill a med. Like you have time to figure this out.
The DCP gets credit when things go smoothly and flack for every other debockled discharge plan. The nature of the beast, and DCP is a beast, is the discharge plan has a right to change until the pt actually walks out the door, regardless of what was previously set up. I spend the bulk of my day doing discharge planning, details, details, details, and unhappy families, under stress families and lots of IV antibiotics after 3 pm on a friday afternoon.
I think it is amusing that the DCP gets flack from the nurses when the ambulance transport is late, like I have any control over that. Also a blast is pts going home and they have no gas electric or running water, or they are not getting help and need new housing. DCP a huge hot mess most of the time.

P.S. to my above post
The only reason I ever stay late, past my 81/2 hrs is discharge planning problems, average I stay is about 10 hrs a week, no OT of course and after a pt is discharged the family still sometimes haunts you.

I'Ve been a discharge planner for a year, but I also share the DCP responsibility with the utilization review responsibilities also. Do you want to be challenged every day? At 45 yrs old, I would like to settle in and just do the job without extra aggravation. Can we trade jobs? LOL

I do not know if I can help you, but telling you of my short experience might give you a glimpse ow a hospital DCP / case manager. There is such an overlap in this position ...it is hard to draw a line. I know of one who is very busy, adn very frustrated. she makes plans for patients needs to d/c patient, then the doctors change the orders in the last minute...and you have to start again to track one w/ little time , before D/c. Also I was a case mgr. and one patient got an order to d/c w/ some DME---- arrangements like this usually goes to the discharge planner, but she missed it and the very disorganized supervisor blame me for missing it! There should be a clariffication as to where your job starts and when does it stop? Using both CM and Discharge planner to plan for the same patient is a waste of time....know where the cut off is.

Hi SanFran Nurse,
I am a hospital case manager and probably 50% of my job entails discharge planning. The other 50% or so involves what I think of as regulatory compliance.....making sure that new admits meet criteria to be in inpt status and doing continuing stay reviews. The posters below have done a good job of outlining some of the real challenges of the job but I have to say that I still love my job a lot. I have done insurance case management and hospital case management and I far prefer hospital case management.

One BIG advantage that we have at my hospital though is that we have social workers who manage all of the uninsured patients. So I am never scrounging for resources for someone who doesn't have insurance or is homeless. It is hard to set up IV ABX for a guy who lives under a bridge! I'd have second thoughts about this job if I had to do that. We still have patients who have poor insurance that while they theoretically have a home health benefit, in reality no home health company will take the business because the pay is crummy. Yes...some families and patients are difficult and present with their list of demands and entitlements but still at the end of they day I am very happy with my work. For every difficult patient I seem to have 10 that I genuinely help and are grateful. I am also blessed that I have a good relationship with the staff nurses, techs and charge nurses on my units and don't catch flack from them. I know how hard their jobs are and they appreciate the complexities of mine.

So....my long winded advice to you if you decide to look closer at hospital case management is to ask a LOT of questions during your interview. Find out exactly what you will be responsible for. I am on call about once every 6 weeks and usually work about 8-5 and I rarely miss lunch!! My case load is sharing a 36 bed ortho & chemo floor and a 12-20 bed women's health floor with another case manager. Our floors turn over fast and I typically have 10-12 new admits a day and that many discharges....just to give you an idea.

Good luck!

I always have 20 patients for all utilization and discharge planning needs that go home. If someone goes to any type of alternative care setting, they are managed by the social worker. My job would be more manageable if there were 1 more social workers for the unit. We have rounds for an hour a day, 5 staff meetings a month and I turnover 8-10 onto a discharge list every day from a med surge unit.
Do any of the utilization nurses out there use canopy to document?

If you dislike doing a lot of paperwork be sure to ask about this during your interview. Perhaps some of the previous responders could also comment on the paperwork involved in DCP. I think there is also a great deal of paperwork in this position. As an onsite case manager following up with patients once they are discharged I obtain a great deal of paperwork from the DCP.

To cap the responses, I believe it is important to know as to who else are the player in the game, and what they do...then clariffy what is your job description among these players and look for overlaps. what do the social workers do aside from finding alternative for care for the uninsured. Is there a separate discharge planners? the hospital that I worked with used LVN's for this. The case manager does UR.....and I tell you this is plenty
!!!! . If your area is within a lot of medical or medicaid patients, and you do not want them to overstay as med nec...then the CM should be able to call and pass it on to d/c planner and if more complicated to soc. worker. Where I work , there was no definition or lines that separates the overlap----and if you have a supervisor that is so disorganized and just keeps making new forms to add up to the paper work , intead of making it efficient, she burdens the system w/ unnecessary , redundant datas.............so I think you need to "interview " the supervisor or the manager of the CM dept. When I saw this, ( she was oblivious of the needs and concerns of the case managers, since she was too busy justifying her position w/ other useless and duplicating paperwork) .
Why do I know this? I was working in VA and was the inpatient coordinator, transfer coordinator, and the UR reviewer. I worked very closely w/ the floor case managers, and with the ER physician to help expedite transfers from an overflowing ER. I also entered datas from Interqual criteria and made a quarterly report to the boards from my data of the percentage of compliance of inpatient criterias. I was the first and the guinea pig for this project , and the medical director helped me make it work. She supported me when the doctors were chewing me alive.... she mandated the order or else.......smoth sailing from there on.
Diffferent players w/ well defined duties/roles was clear, and this made working as a team a wonderful experience.
bottom line....the supervisor /manager must work with you and not against you. good luck! do not be afraid to ask questions....an interview must be a two way process and you should interview your employer as well.