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August 27th, 2014

Don’t Skip Your Case Conference

When a loved one is a resident of a nursing home for rehabilitation, whether for the short or long term, assuring that he or she receives the best possible care is, of course, paramount.  While every case and every individual is unique, there are certain general rules that make optimum care that much more likely.   

1.    First, be there as much as possible.  Though we would love to say that every resident is treated equally, the fact is that most facilities are understaffed or at best have heavy case loads.  So, unfortunately, staff does make choices about giving care and as an advocate for your resident, it is perfectly okay to be selfish by being there often.  When the staff knows that there is a caring person who will visit, ask questions about treatment and gently though persistently point out any deficiencies, that the person that will get the most attention.

2.    Key to a resident’s well being is the case conference.  It is there that the health care professionals in the facility get together, exchange information and compose a coordinated strategy.  Present at the conference should be the resident’s case worker, physical therapist, occupational therapist, head nurse, possibly the nutritionist and if you are fortunate, the resident’s doctor.  It is vital that you be there as well as an advocate and, if at all possible, your loved one should be there as well.  Often it is necessary to actually request early and frequent conferences and push for a time that you will be readily available.

Preparation for the conference is extremely important for the conference to be a success.  Prepare a written list of what you see as the goals for your resident such as, “being able to stand up from bed or chair and transfer to a wheelchair or walker” or “ability to walk to the bathroom with aid of the walker.”  Then list questions for each of the people that you might know will be there.  “How many times a day has she been receiving physical therapy and occupational therapy?”  “What were the results of the latest sessions of each?”  “What special arrangements have been made from the nutritionist to ensure that sufficient food is being received given his special condition?”  “What is the specific diagnosis?”  “What is the prognosis as far as being able to be released to home and what is the time table?”

If you plan to attend with another relative, get together before hand and compile goals and questions together so that the meeting is more focused and not repetitive.  In some cases, give the social worker a copy of your questions in advance to distribute to those who will be at the meeting so you will have the chance of receiving appropriate answers then and there.  There is nothing more frustrating than being told that they will check out an answer and get back to you.  Some do and some don’t.  If your resident is there with you, let him or her ask questions as well.  Before you leave, set a date and time for a follow up conference in the next few weeks.  Get a list of the names, contact information of everyone present and what their position is in the facility.  Business cards are helpful if they have them.   If successful, the case conference will result in the care planning being very specific to your loved one and moving along very quickly toward your goals. 

3.    Finally, prior to your resident being released home, a facility is required to prepare a discharge plan.  While you should not have to ask for this, it is certainly a good idea to check to see that it has been done and go over all the details with the social worker.  Since they are required to provide for a “safe discharge” (it is a good idea to remember that specific term), you need to make sure that the plan that has been written in the abstract actually matches the reality of the situation once your loved one returns home.  They can’t return someone who can only walk with a walker to a three-story walk up.  They have to ensure that there will be enough help at home – home health aides, physical therapist, occupational therapist, nurses, etc.  This should all be paid by for Medicare for at least a few weeks.  Often, there are tasks and preparations for the family which, of course, you need to know in advance.  For example, ordering a hospital bed is not something you can do on a day’s notice.  If there are things that you or the family members need to do, the social worker should be able to help you and give you step by step instructions and phone numbers if necessary and, of course, the contact information of who you can call at the facility if there any glitches in the plan.  Also, you need to know what to do once Medicare coverage is over and who you can contact in the event that you need another few weeks. 

Community Medicaid may be necessary if the coverage runs out but the need is still there.  A thorough, well executed discharge plan is the best path to a speedy recovery.

Sanford R. Altman is an attorney practicing elder law, estate administration and estate planning with Jacobowitz and Gubits in Walden. He is a member of the AARP Legal Services Network and chairman of the Town of Montgomery Seniors Independence Project. This column is intended to give general legal information, not legal advice.

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