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.

**no references available

SOLUTION – Elderly client newly diagnosed diabetes and recovering from open heart surgery complicated by pneumonia

a. Difference between Care Management and Case Management:

• Care Management: Care management focuses on coordinating and managing the delivery of healthcare services to meet the patient’s needs. It involves assessing the patient’s needs, developing a care plan, coordinating services, and monitoring the patient’s progress to ensure they receive appropriate and effective care.
• Case Management: Case management, on the other hand, is a broader term that encompasses care management but also involves advocating for the patient, coordinating services across multiple providers and settings, addressing psychosocial needs, and ensuring continuity of care. Case managers often work with complex cases or patients with multiple health issues, disabilities, or social challenges.

b. Proprietary Agency:

• A proprietary agency is a type of home healthcare agency that is privately owned and operated for profit. These agencies are typically run by individuals or corporations with the primary goal of generating revenue. They provide various healthcare services, including skilled nursing care, personal care, and therapy, to clients in their homes. Proprietary agencies may offer a range of payment options, including private pay, insurance, and government programs like Medicare and Medicaid.

c. Skilled vs. Non-skilled Nursing Care:

• Skilled Nursing Care: Filling insulin syringes would be considered skilled nursing care as it requires specialized knowledge, training, and judgment to safely administer insulin and monitor the patient’s response. Skilled nursing care also involves assessing the patient’s condition, managing medications, performing wound care, and providing education and support to manage chronic conditions like diabetes.
• Non-skilled Nursing Care: Getting someone to pay the healthcare bills on time would be considered non-skilled nursing care as it does not require specialized medical knowledge or training. Non-skilled care may include assistance with activities of daily living (ADLs), meal preparation, light housekeeping, and companionship.

d. Examples of Intrinsic and Extrinsic Factors Related to Falls:

• Intrinsic Factors: Intrinsic factors are internal factors that contribute to falls and are related to the individual’s physical or cognitive condition. Examples include:
  • Muscle weakness or loss of balance
  • Visual impairment
  • Cognitive impairment or confusion
  • Medication side effects (e.g., dizziness, sedation)
• Extrinsic Factors: Extrinsic factors are external factors in the environment that increase the risk of falls. Examples include:
  • Slippery floors or uneven surfaces
  • Poor lighting
  • Inadequate assistive devices (e.g., grab bars, handrails)
  • Clutter or obstacles in walkways
  • Improper footwear

Identifying and addressing both intrinsic and extrinsic factors is essential in developing a comprehensive fall prevention plan for the patient.