Case Management

At Grand View Health, our nurses, doctors and staff work together to speed your recovery. As a patient in the hospital, you may receive different services, such as tests, evaluations and treatments. Your case manager coordinates your care to maximize your health and comfort. They also make sure that your physician and every other member of your healthcare team is kept informed.

Meeting Your Case Manager

You will usually meet your case manager shortly after admission. Case managers are nurses, social workers and other healthcare professionals who will be available to you and your family throughout your stay. If you would like to see a case manager and one has not visited, call the case management department at 215-453-4487.

Understanding Your Options

Your case manager will explain your options and help you understand the healthcare system. We will ask you to think about your healthcare goals, doctor’s instructions and insurance coverage.

If needed, we will explain your options related to advance directives. These include living wills and power of attorney for healthcare. Occasionally, you or your family may need help in reaching a decision regarding your care. Your case manager can arrange for you to speak with our chaplain or members of our ethics committee.

Coordinating Health Insurance Benefits

Your case manager works with your insurance provider so you get all of the insurance coverage that you are entitled. Types of insurance include Medicare, Medical Assistance, veterans insurance and private insurance, such as Blue Cross and Aetna. Your case manager coordinates health insurance benefits and obtains approvals while you’re in the hospital and in preparation for your discharge.

Case Management Services After Discharge

Your doctor decides when it’s safe for you to leave the hospital. Your case manager makes the best recommendation for your care within the medical orders provided by your physician and services provided by your insurance. If you are not going home, you may be transferred to a rehabilitation center, skilled nursing center or assisted living facility. If you are going home, your case manager can arrange for medical equipment, nursing and other healthcare services in your home.

Case management services are available after you leave the hospital. Our outpatient case manager can connect you with services available in the community even after you leave the hospital. We will give you the names and telephone numbers of people to contact, explain what you might be entitled to receive and help you complete forms.

Services Case Managers Consider When Planning Your Discharge

• Rehabilitation: Your case manager will work with your insurance company to see if your admission to a rehabilitation facility would be covered. If yes, we will help you find a facility.

• Skilled Nursing and Assisted Living (Personal Care) Facilities: Case managers will provide a list of facilities and encourage you or your family members to visit the ones that interest you. If the facility you prefer does not have an opening, you will need to choose another one. Patients cannot remain in the hospital while they are waiting for an opening in another facility unless they are willing to pay the daily hospital rate. The cost of staying in assisted living facilities is not covered by Medicare or most private insurance plans. However, some long-term care insurance policies do cover the costs of assisted living or skilled nursing facilities. Your case manager can help you with financial and insurance questions.

• Home Healthcare: Your insurance may cover healthcare services in your home. Typically, services are provided for an hour or two—one or more days a week. These might include nursing, physical, occupational and speech therapy, home health aide service or medical social work. To receive home care coverage, Medicare and most private insurances require that you are homebound.

• Hospice: Hospice provides home health services and support to individuals diagnosed with a terminal disease or are living with a life-threatening illness.

• Medical Equipment: Your case manager can help you obtain necessary medical equipment, such as home infusion (IV), wheelchairs, walkers, ambulatory aids, hospital beds or oxygen. Grand View Medical Company offers home medical equipment and supplies, and most insurances cover this equipment. For more information call 215-249-4600.

Contacting a Case Manager

Case managers work Monday through Friday from 7:30 a.m. to 5 p.m. In emergencies, you may reach a case manager by calling the hospital operator and asking to speak to the on-call case manager. Our goal is to help you leave the hospital by 1 p.m. Please arrange for a family member or close friend to give you a ride. Let your case manager know if you do not have a way home from the hospital.

Expectant Mothers, Infants and Children

Many services are specifically designed to meet your special needs. Your case manager will inform you about services, such as home health, medical equipment and referrals to county and community agencies specializing in pregnancy support and children and youth programs.

Government and Community Resources

County programs, such as Area Agency on Aging and Adult Services, provide many services that you may qualify for. These include Meals on Wheels, homemaker services and financial assistance. Your case manager can inform you of these services and help make connections for you to receive them.