As a nurse leader, a case manager and a nurse advocate I strive to be a good communicator, a networker and skilled at resource management. 2020 put us all into isolation and shut down travel, conference, and onsite meetings that allowed us to meet vendors, colleagues, as well as families and friends.

Last week, I was reminded of the importance of these competencies as I worked a challenging case. It also reinforced that I am not a 1-800-Hell-No-Case Manager!

Here is the story.

I have been working with a family whose brother had cervical neck surgery in early November. Two days after surgery he was discharged to his sister’s home to recuperate. Once home, he seemed to be doing well, but on Day Two he started to have trouble breathing. The sister called 911, and he was taken to the closest hospital, where he was intubated and put on a ventilator. He had a rocky hospital stay, required prolonged intubation, and eventually had a trach placed to secure his airway.

After the trach was placed, he stabilized but was debilitated due to prolonged bed rest and the toll the experience took on his body. As he stabilized medically, the social worker and I started to look at the next steps. The goal was to get him to an acute rehabilitation hospital program so he could work to get back to his baseline. He was only 56 years old, and before the cervical neck surgery, was an active man who worked as a plumber.

His insurance company provided the list of rehabilitation centers that were in the network. All were contacted but refused him as he had a trach, was on tube feeding, and could not do the three hours of therapy needed to meet the requirements.

I felt like we were at a dead end. I called for a family conference so the family could understand the dilemma and look at what their options were. At the meeting, the social worker explained that the patient did not need to be in the hospital and would have to go home or to a nursing home. The brother and sister were devastated. The brother lived out of state but came down to help his sister. The patient had a Florida only health insurance policy, so going home with the brother was not possible. The sister was exhausted and knew she could not take care of him.

The Social Worker explained that due to COVID, it would be hard to get him into a nursing home, but she would put out a search to see where a bed was available. When I left the meeting, I felt defeated.

As I thought more and more about the situation, I felt that the man deserved a chance at acute rehab. I knew that once he got to a rehabilitation hospital, he would improve – he just needed someone to take the chance on him.

Using Your Network

Before the pandemic, I worked with a colleague to set up a case management meeting to introduce case managers to a new rehabilitation hospital that just opened in Miami. We never had the meeting due to COVID-19, but I called my contact and explained the situation. She said, “we can look at the patient, and if the insurance covers him, we can consider taking him, but we would need a discharge plan if things did not work out”. I told her that I would stay involved and help with Plan B as needed. I could not believe it – I felt hopeful and was go grateful.

I called the social worker the next day to give her the news. She promtly sent over the clinical information; and I contacted the insurance company and explained that I found a program to take the patient. They checked, and the rehab hospital was in their network. The rehabiliation center knew the patient was a risk for them, but they are used to dealing with complex patients and saw his potential. The transfer happened last week (yes, this all occurred over the Christmas/New Years’ holidays).

Today, the man is making improvements. His trach is capped. He is talking, eating, and actively participating in rehab. He sees a future, as does his brother and sister. I am keeping in touch and dealing with outstanding issues, but overall, things are going well.

I believe that the transfer would not have happened if I did not have a good relationship with my colleague at the rehabilitation hospital. This experience reinforced the importance of communication, networking, and knowledge resources to meet the needs of the patient’s.

The experience also reminded me of what my friend and colleague Nancy Skinner says when she speaks to a case management audience. She reminds us that we are not 1-800- Hell-No-Case-Managers. This is because Case Managers and Patient Advocates are in place to effect change, to make things happen. We advocate for our patients, and we look for resources till we find something that will meet the individual needs of the patients we are caring for.

I know all case managers are under tremendous pressure with COVID, but we can do remarkable things when we work together.This case showed the power of teamwork, collabiation and the importance of cultivating relationships with vendors.

Thank you for reading this post. If you have had an experience like this, let me know how you handled it.



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