Exam 8: Transitional Planning Across the Continuum of Care

In some instances, family members can be hired by the patient to provide chore services via _____________________________.

June was in the hospital for surgery to repair a broken hip. She is 92 years old and has lived alone since her husband died 2 years ago. She has eight children. Six of the children live locally and have said they can be available "some" to help out. They have put together a caregiving rotation, and someone can be with June every day for several hours, but no one can spend the night with June. June would like to go home if she can. You are getting ready to meet with June to discuss her options. What would be the best discharge option for June?

Basic care, which is routine, custodial care in an extended-care facility, is paid for by Medicare, but only for the first 100 days.

Under the DRG-based payment system, the fees for inpatient hospital care are "bundled" into a single fee for reimbursement.

Robert's mother, Liza, has dementia. He has been able to care for Liza in his home, but he is worried he will no longer be able to care for her at home. He came home from work one day this week, and the front door was wide open. Liza had taken the dog out and forgot to close the door when she returned home. Robert meets with you to discuss placement options. After reviewing the fact that Robert is still able to care for his mother when he is home, Robert opts for ________________________.

__________________________ is determined on the basis of current diagnosis, prognosis, impact, and treatments required.

One reason few hospitals use the RED model of discharge planning is that the cost to administer this program is not offset by additional money generated from readmissions.

Allison works as an inpatient social worker for a healthcare system. She assists with discharge planning. The healthcare system has its own home healthcare department, which Allison knows provides very good care. Allison automatically refers all her patients to this agency. After all, the patients have chosen to use the system for their inpatient care, the care offered by the home health department is fantastic, and it makes it easier to coordinate care because she is friends with most of the home health social workers. Is Allison practicing ethically? Why or Why not?

Dr. Johnson expressed frustration that the physician from a patient's insurance company did not agree with Dr. Johnson's plan of care. Dr. Johnson noted that the insurance company's physician did not practice the same area of medicine as Dr. Johnson and felt this should disqualify the insurance company's physician from acting as a _________________________. In Dr. Johnson's opinion, the insurance company's physician was unable to understand the rationale for Dr. Johnson's plan of care.

Emma is an 85-year-old woman who lives alone in a small apartment. She has a small kitchenette but can also go to the dining room for meals if she wants. She values the independence she has but finds security in knowing there are other residents her age in the complex, as well as assistance with some services like cooking and laundry. Emma lives in a(n) ____________________.

Patients, especially the elderly, are most vulnerable when __________________.

After meeting with June, the 92-year-old woman who broke her hip, you wonder if there is some alternative to a nursing home placement. You call the Area Agency that serves June's county and learn that the ______________________ list is open, and June does qualify for additional services in the home. You are pleased to present this new alternative to June, because she really wanted to return home at discharge.