As a nurse, you are caring for an 82-year-old woman who has returned home after abdominal surgery to repair an inguinal hernia, needing dressing changes and IV antibiotic therapy. Upon your arrival, her daughter meets you at the door and requests a private conversation after her mother’s care is complete. While your client is sleeping, her daughter relates her numerous concerns about her mother’s safety if she remains living at home alone. She indicates that her mother loses her keys on a weekly basis, forgets to pay her utility bills, and continues to hoard the food her daughter delivers weekly, eating very little.

a. What are your priorities regarding case management?

b. What are your priorities regarding care management?

c. How should the daughter’s safety concerns be addressed?

You are caring for a home care elderly client with newly diagnosed diabetes and recovering from open heart surgery complicated by pneumonia. The patient is on two medications. The patient is having difficulty getting in and out of bed and taking a shower and has leg cramps. The family has a contract with a proprietary agency to assist with activities of daily living two hours a day. The case manager made arrangements for continuity of care from the hospital to the home setting.

a. What is the difference between care management and case management?

b. There are a variety of reimbursement mechanisms that have evolved over time in home healthcare. This patient is being managed by a proprietary agency. What is a proprietary agency?

c. Both skilled and nonskilled nursing care has to be performed in the management of this patient’s diabetes, including filling insulin syringes and getting someone to pay the healthcare bills on time. Which one is skilled and which one is nonskilled nursing care in this situation?

d. The patient is having difficulty getting in and out of bed and taking a shower, and has leg cramps. The patient has fallen four times in the last 6 months. What are examples of intrinsic and extrinsic factors related to falls.

Case Management Priorities Solutions

. Priorities Regarding Case Management:

1. Conduct a comprehensive assessment of the patient’s health status, including physical, mental, and psychosocial needs.
2. Develop a personalized care plan that addresses the patient’s post-surgical recovery, including dressing changes, IV antibiotic therapy, and pain management.
3. Evaluate the patient’s ability to perform activities of daily living (ADLs) independently and assess any functional limitations.
4. Coordinate with other healthcare professionals involved in the patient’s care, such as the surgeon, primary care physician, and home health agency, to ensure continuity of care.
5. Assess the patient’s home environment for safety hazards and provide education to the patient and family on fall prevention strategies and medication management.

b. Priorities Regarding Care Management:

1. Provide skilled nursing care for wound care, medication administration, and monitoring of vital signs.
2. Collaborate with the patient’s healthcare team to address any complications or concerns related to the surgery and pneumonia.
3. Educate the patient and family on diabetes management, including medication adherence, diet, and blood sugar monitoring.
4. Coordinate with the home health aide from the proprietary agency to assist with activities of daily living, such as bathing, grooming, and mobility.
5. Monitor the patient’s progress and response to treatment, adjusting the care plan as needed to optimize outcomes.

c. Addressing Daughter’s Safety Concerns:

1. Listen attentively to the daughter’s concerns and validate her feelings.
2. Assess the patient’s cognitive function and memory to determine if there are signs of cognitive decline or dementia contributing to the safety issues.
3. Explore potential solutions with the daughter, such as installing a key rack near the door, setting up automatic bill payments, and discussing meal delivery services to ensure proper nutrition.
4. Consider involving additional support services, such as home health aides or companions, to provide assistance and supervision for the patient as needed.
5. Discuss the option of a comprehensive geriatric assessment to further evaluate the patient’s needs and develop a tailored care plan to address safety concerns while promoting independence and quality of life.

a. Difference between Care Management and Case Management:

• Care Management: Focuses on coordinating and managing the delivery of healthcare services to ensure that the patient’s needs are met effectively and efficiently.
• Case Management: Involves the development and coordination of a comprehensive plan of care for a specific client or patient, often including multiple healthcare providers and services.

b. Proprietary Agency:

• A proprietary agency is a private, for-profit organization that provides healthcare services, such as home health care, for a fee.

c. Skilled vs. Nonskilled Nursing Care:

• Skilled Nursing Care: Includes activities that require specialized knowledge and training, such as medication administration and wound care.
• Nonskilled Nursing Care: Involves assistance with activities of daily living (ADLs), such as bathing, dressing, and grooming, which do not require specialized nursing skills.

d. Intrinsic and Extrinsic Factors Related to Falls:

• Intrinsic Factors: Include factors related to the individual, such as age-related changes in balance and mobility, cognitive impairment, and chronic health conditions.
• Extrinsic Factors: Include environmental factors outside of the individual, such as slippery floors, poor lighting, clutter, and lack of assistive devices or grab bars.