case management in home care

  1. Hi everyone! I need your help! I work in a hospital based Homecare, average census of around 120-150 patients. We are trying to find a case management model that REALLY works. Right now we have 4 RN's who work as "Case Managers", For the most part they do all of the Admits then assign the patient to one of the "primary" nurses (approx 7 or 8, depending on staffing) Usually the CM's do 2-3 opens a day, sometimes less, never more than 3. Caseload for primary SN is usually 5-6. Problem is with paperwork, time constraints, staffing etc. we never seem to have the time to communicate with each other and everyone seems to be just doing their own thing! There seems to be a constant battle over who is supposed to do what, sometimes the CM's open and never see the patient again, and don't seem to worry about it. Insurance calls are being missed, some primarys still want to "keep" their patients forever, (esp. nurses who have been around a while) and its a mess! Any ideas or examples of what your agencies do will be greatly appreciated!!
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  2. 6 Comments

  3. by   hoolahan
    Hi Barb,

    I can see where that may get a little territorial. If a case manager is assigned, they need to manage the case, that means requesting additional visits from insur co's or at least submitting the appropp forms to the intake dept, tracking all disciplines, etc...

    At my agency, all FT and PT RN's are case managers. Per diem RN's can choose to case manage if they want to, but usually they do visits only an RN would do, like admits, HHA sup's, etc... and any other types of visits that are leftover. As a per diem RN I have done 3 and on occassion 4 admits a day, and I honestly do NOT know how it would be possible to CM 30+ pt's each day, and still complete all the paperwork for 3 admits!! That is asking a bit much.

    Each Case manager , who may or may not be the admit nurse, gets a tickler card, with pt info, like a teensy weensy pt cardex. Every chart gets a calendar for the entire 60 day episode, so nurses can track q2w HHA Sup, last day of auth's, how many visits have been made etc... Each case manager has a voice mail, so if a discipline want to leave a report, they can, then the CM has to document the call in the progress notes. If another nurse happens to run into a discipline in the field for a joint visit, we just document that in our notes under the interdisciplinary section. The case manager is responsible for all follow up. OK, I would hope that another nurse would try to get the am labs results to the doc, but not all do, so it is my job to be sure to follow up. If I will be off the next day, I write up the fax forms so all the secretary has to do is fax it to the doc for me, a nurse already reviews them, and the lab must call all criticals.

    The FT'ers can usually claim a building, like a senior building. Since I just went FT, I get 3 pt's in one city building, and the senior building 3 miles from my house, it's still in the city, and I like this building very much. We are on geographical teams, by zip codes, then each team has a few CM's, who are again subdivded into townships, and we all share the city. This also generally keeps the nurses happy, and the pt's b/c while they may not see the same nurse each visit, they see the same faces again and again. This helps to lower mileage expenses for the agency as well.

    Do you all use beepers or cell phones. I know some agencies are trying to get away from the liability of cell phones if driving, but we have a combo cell-walkie talkie, so we can use the walkie and don't have high cell bills. I will simply say they suck as cell phones lousy signals, but as walkies, they are usually pretty good.

    Anyway, not sure what this "model" is called, if it is one, but that is how we are set-up. If you want to ask me anything else, please post, I'll be happy to help. It will be interesting to see how everyone else does things. This is basically the same way the other agency in my same area is set-up as well.
  4. by   barb b
    Thanks Hoolihan! That does help alot. We are having a meeting next week to try to see what we can do to make this work. Yes we do use pagers & cell phones but we are piloting one or two Alpha pagers to try & cut down on the need for call backs, Also if the message doesn't need to be returned right away the message is left on our voice mail & we are paged to our phone. that way we don't have to interrupt Pt. care & can check it at our convenience. Thanks for your help, were all in this together!
  5. by   NRSKarenRN
    I case managed 4 years from the field...almost impossible to do now as insurance Co's in my area want TYPED forms faxed to them with clinical update then they fax back auth in 48 BUSINESS hours. The BLUES still call two x a week with auths and want verbal report although they've implimented faxing forms too.

    Alphanumeric pagers are the way to go--cuts down on phome calls can leave message who and when to call or just say " check voicemail stat" if lengthy immediate message needed to be relayed. You can have up to twenty messages saved on our pagers, then return calls as you are able too, instead of calling immediately to see if urgent or not.

    Never worked in agency with only admit RN's.
    Current and previous agency's worked similarly.

    WE handle 700-800 admits a month.
    Clinical manager inhouse covers Medicare and insurance patients for a geographic area. They assign staff, get auths, review paperwork/OASIS and receive reports from other disciplines: HHA, PT, OT etc and write communication note--mostly from Voice mail then pass messge to case manager in field; auth forms are in triplicate so field nurse case managing patient gets copy in patients folder in office file drawer. Field travel chart kept with this info and calendar placed on front for scheduled visit patterns which per diem staff check. Cell phones used to contact patients, doctors, labs etc.---flat rate $20.00 given RN with sumittence of monthly phone bill.

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    6 years ago I had 100 mile travel range as infusion RN---phone bill for 650 minutes was $200.00---before all these package deals came about so choose wisely--issues of patient privacy with cell phones an issue too.
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    One agency in my area also had above CL managers along with Insurance manager for each different insurance company. You would leave voice mail for one mgr and copy to another----all havoc reigned if you forgot to copy report. RN's uncomfortable with voicemail or pagers did NOT last in this agency.
  6. by   nursemicke
    I have worked for several home care agencies. Shands in Gainesville, Flordia was the best. Call them and tell them you are new and would they please help. Debbie Meyers was the manager and a great person.
    Anne
  7. by   momof3RN2B09
    Quote from nursemicke
    I have worked for several home care agencies. Shands in Gainesville, Flordia was the best. Call them and tell them you are new and would they please help. Debbie Meyers was the manager and a great person.
    Anne
    can you give me details on how shands homecare compares to other agencies, like gentiva? I am considering a position at shands homecare and am wanting to make sure I have as much info as possible. how do they pay? do they provide vehicle, or cover expenses? are the schedules flexible? paperwork? computers? any info would be much appriciated.
  8. by   KateRN1
    This thread is over *8* years old and nursemicke has not posted on allnurses since December 2008. You might get a response if you PM her and she has notification turned on.

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