[AtlantaRN]

As case managers, does your company rely on you to evaluate and decide when continuous care should start for a patient?

Also, once continuous care is started---is it still your responsibility to re-evaluate the patient several times a day to decide if continuous care is still appropriate?

Thank you

linda

[aimeee]

The case manager must call their own team manager or the continuous care team manager to discuss whether the situation qualifies for continuous care and to find out what kind of staffing is available. Once in place, they must visit daily to evaluate how the interventions are working and make adjustments to the plan of care. This includes a call to the manager again so there can be a discussion of how things are going and decisions can be made about staffing for the next 24 hours.

A case manager would only visit multiple times in one day if the interventions were not working and her physical presence was needed for additional evaluation. I should also mention however, that we rarely use HHA's for continuous care except when we are doing it in a nursing facility. In home situations we usually find that we really need the skill level of a nurse for medication titration, administration, and family education. Also, we do not usually staff the entire 24 hours as continuous care. Very few situations require the presence of staff constantly. There are many situations where help getting through the night-time hours with a consistent medication regimen is enough to resolve the situation.

[dosamigos76]

I have found that different companies work CC differently. The company I am currently with doesn't use CC that often. I agree with the above poster, there shouldn't be a reason for the RN CM to assess the patient more than daily unless the interventions are not working.

The regs actually do not say that the RN HAS to see the pt daily, just that they are supervised by the RN CM. I personally believe that if a patient requires CC, the RN CM should be there daily. Also, the relationship that you have established with either the patient, family and/or facility is important and you are needed more than ever at that time.

We did use CNA's during the day when family could give meds and provided LVN's in the pm, but like anything else that would be adjusted to fit the situation or facility.

HTH,

Cheryl

[Buckyxj]

I am part of our Urgent Care/ Continuous Care staff. we are one of if not the only hospice in this area to provide 24hr. care by a LPN/LVN at the end stage of life or if thought necessary to control patient symptoms or family comfort. The case manager comes out to assess q 24hrs. We have two LPN's on staff all three shifts that are Urgent Care/ CC staff. Many times its not needed but the family is greatful when we are there.