presented by Tina Marrelli & Kim Corral
The home health industry demands that patient care be provided in an efficient and effective manner. Case management is a strategy which supports this demand. This course defines the concept of case management and discusses the skills and core knowledge concepts required to manage not only individual patient episodes but entire caseloads of patients. Strategies for applying this process to individual patients and caseloads will be discussed with practical examples that can be applied in the care practice setting.
Tina Marrelli is the president of Marrelli and Associates, Inc., a publishing and consulting firm working in home care for more than 30 years. Tina is the author of 13 books, including the Handbook of Home Health Standards: Quality, Documentation, and Reimbursement, (6th edition, 2018). Other books include A Guide for Caregiving: What’s Next? Planning for Safety, Quality, and Compassionate Care for Your Loved One and Yourself (2017), Hospice and Palliative Care Handbook (3rd edition, 2018), The Nurse Manager’s Survival Guide (4th edition, 2018), and the best-selling home health aide educational system, Home Health Aide Guidelines for Care: A Handbook for Care Giving at Home and its accompanying Nurse Instructor Manual. Tina served on the workgroups that defined the first hospice nurse standards as well as serving as a reviewer in 2014 for the revised Home Health Nursing: Scope and Standards of Practice through the American Nurses Association. Tina attended Duke University, where she received her undergraduate degree in nursing. She also has master’s degrees in health administration and in nursing. Tina has worked in hospitals, nursing homes, and public health and has practiced as a visiting nurse or manager in home care and hospice for more than 20 years. Tina also worked at Medicare’s central office (CMS) for four years on Medicare Part A home care and hospice policies and operations qnd served as the interim branch chief for Medicare Part B. Tina loves policy and the nuances that frame care, practice, and delivery. Tina is an international health care consultant, specializing in home care and models of care provided in the community to people at home. Tina and her team of specialized consultants have been in business since 2002 and provide services related to the “design and implementation of challenges to providing home and community-based care.” In that capacity, they have served more than 100 clients throughout the world, clients who represent varying segments of service to home care and/or related products. Services include custom presentations, software development, educational services, serving as Team Leader with a team that served as quality monitors to the OIG, accreditation services, new organizational start-ups, due diligence, feasibility studies, and more. Tina has been the editor of three peer-reviewed publications, most recently for Home Healthcare Nurse (now Home Healthcare Now), on which she served as the editor-in-chief for eight years. She is also an emeritus editor for Home Healthcare Now. In addition, Tina serves on the editorial boards of the Journal of Community Health Nursing and The American Nurse. Tina is the Chief Clinical Officer for e-Caregiving, www.e-Caregiving.com, a web-based support and educational system for family and friend caregivers created to support advocacy and improve care across the health care continuum.
Kim is a registered nurse with a master's degree in Education and over 30 years of home health experience. She is an experienced leader in home health care, having held both clinical and operational positions at regional and national levels for large corporate home health organizations. She brings a passion for providing the clinical voice of quality, while increasing efficiencies. She has extensive experience speaking for state home care associations, national home care organizations, and local home care organizations on regulatory compliance, successful strategies for clinical/operational success, OASIS data collection and strategies, quality outcome improvement, developing successful QAPI programs, documentation standards, and operational processes to support OASIS and ICD-10 accuracy.
The term "case management" is utilized in home health to describe a method of oversight that is practiced to effectively manage patient care episodes. This method focuses on the ability to accurately assess the acuity of home care patients as well as the ability to provide and coordinate high-quality care that appropriately meets the patient's needs. The case manager is responsible for managing multiple patients holistically and across time, and this concept provides the framework.
The provision of patient care in the home can at times be a daunting task. Providing care in the home requires a specialized skill set that includes experience in clinical practice, leadership skills, strong reasoning and decision making skills, organizational skills, and more. As one can imagine, the home care practice setting is not for everyone. In this chapter, we examine the desired attributes of a case manager and the scope of this very important role.
There are many aspects of care that must be managed throughout the course of a patient episode. This chapter identifies the specific areas that require close supervision, oversight, and management. A patient example is shown to better illustrate these complexities.
Provision of patient care in home care is more than providing specific tasks to a patient. The patient must be considered/assessed from a holistic perspective, meaning the home care clinician is responsible for identifying not only patient medical problems but the problems associated with the environment in which the patient lives that may impact their ability to medically improve and successfully achieve desired outcomes. The home care clinician must develop an appropriate plan to support mutually agreed upon goals for improvement in the patient environmental situations that impact care as well as support improvement of their medical status. Once this individual plan is developed, it must be managed. The individualized patient plan of care is the road map clinicians utilize to assure that the care is managed effectively across all disciplines. This chapter looks closely at the aspects of patient care that must be carefully managed.
Successful caseload management is directly related to the organizational skills of the case manager. This chapter discusses organizational strategies and tips to support effective caseload management. There are different models for the organization or oversight of care management. Some of the ways to effectively manage caseloads will be presented and explored.
Healthier, happier patients and community can have a lot of benefits, including improved clinical and financial outcomes. This can lead to better relationships with referral sources and physicians. This chapter discusses the ways positive case management can impact home care.