May 2013 - Navigating a Changing HealthCare LandscapeHow do you know how to navigate the complex healthcare and support service systems? How do you evaluate the options given to you?
Increasingly, patients are expected to manage their own medical and support care. But it can be overwhelming and confusing. PSRC is expanding our resource services through PIC Princetonsm to help you get the care you need.
Health care has evolved dramatically over recent decades and now the Affordable Care Act is initiating several changes. Procedures that once kept you in the hospital for days or weeks are now done in outpatient surgery, sending you home the same day. Techniques like laser surgery have transformed medicine, and studies show that it’s better to get moving again quickly and to get away from potentially life-threatening infections that can be acquired in the hospital. Research also illustrates that there are significant cost savings with home-based care. But this also means that you come home in a more fragile condition needing more care. This can be problematic if you don’t have a support system to care for you.
Studies indicate that many people do not follow the recommendations for follow-up treatment, leading to further complications and re-hospitalization. The Federal government (through the ACA) is piloting several initiatives to improve outcomes and reduce costs to Medicare and Medicaid.
Often a person also needs non-medical services such as transportation, meals, and homecare. Where do you start when you hear “your family member can no longer be left alone?” Or you may need to explore whether there are assistance benefits that will help pay for care.
Several hospitals, including Princeton HealthCare, have initiated a new care transitions program, where a transitions coach meets with a patient once or twice before and after discharge to ensure that you understand and can follow the recommendations. This is a short-term relationship focused on a single episode and diagnosis. It is critical that there be a smooth transition from hospital doctors, treatments and medications to outpatient care. Hospitals that experience fewer readmissions will be rewarded financially.
Now that there is so much emphasis on home-based care, there are a growing number of options for case management or care coordination. There are so many medical and social services that you may use, usually with different providers, which takes a lot of coordination. Your needs are likely to change over time, so frequent adjustments need to be made. A professional navigator knows the area resources and how to access them, as well as being aware of factors you may not have thought of.
Here are some of your options:
Geriatric Care Managers –professional social workers and nurses who assess, plan and coordinate care. They are available 24/7 and many will accompany you to appointments. Some businesses provide additional services themselves (such as homecare).
· Homecare Agencies –Many homecare agencies are now stating they include care coordination as an ancillary service if you are using their home health services.
· Physician’s Offices – Some medical groups are now including care managers for their frail clients who have complex medical conditions. Medicare is rewarding practices for reducing costs for these patients.
I recently met with a couple who had been through a hospitalization and follow-up care. As they navigated through the system, they met with many of the services listed above. It was apparent that it could be confusing to sort out all these coordinators, especially if one gets conflicting recommendations. So how do you decide what is right for you?
Some questions that may help you decide:
Would it be helpful to have someone to guide you?
Do you need help for a single incident or want ongoing support?
Do you need to have someone available 24/7?
What are the person’s credentials and length of experience? Do they belong to professional organizations?
Is care coordination the primary work of the organization?
What are the initial and ongoing costs?
Do you trust and feel comfortable with this person?
Is the person there when you need them?
The decision between these services may depend on how much and what kind of support you need/want and your financial resources. I strongly recommend having a care coordinator or care manager if you do not have supportive family members nearby.
Discharge planners and care transitions coaches are short-term and focus on a single episode of
care, tending to focus on the medical issues. A care coordinator or case manager will build an ongoing relationship with you regardless of where you are living or receiving care. They look at the larger picture of your resources and needs on many dimensions and can coordinate both medical and other support services. They are very knowledgeable about housing options, homecare, resources and medical care. They can connect with discharge planners, residential community staff, transitions coaches and family at a distance.
PSRC’s PIC Princeton program provides care coordination. We will work with you, your family and any other medical or service providers to ensure seamless transitions and comprehensive, coordinated care with good communication. We build long-term relationships so that we will know you and your support system so we can help when you need it.
Because of the new Federal incentives, the array of home and community services will continue to grow and become more complex. If it is confirmed that home-based care is more cost-effective, and as more people live longer at home with chronic conditions, more of the care coordination and direct care will fall to family caregivers. Call if you want to discuss your options or learn more about PIC Princeton.
Susan W. Hoskins LCSW