Case Management Post-Discharge Care Planning

Through the Grand View Hospital Case Management Department, a number of services are considered as we help plan your post-discharge care.

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

Skilled Nursing & Assisted Living Facilities
Grand View Hospital staff will give you a list of skilled nursing and assisted living (personal care) facilities and encourage you or your family members to visit the ones that interest you. After you decide where you might like to go, your case manager will help you complete your application forms. If the facility you prefer does not have an opening, you will need to choose another one. You may not remain in the hospital until an opening arises, unless you are willing to pay the daily hospital rate.

The cost of staying in assisted living facilities is not covered by Medicare or most private health 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 your financial and insurance questions.

Home Health Care
Your insurance may cover health-care services in your home. Typically, services are provided for an hour or two, one or more days a week. These might include nursing, physical therapyoccupational therapy or speech therapy; home health aide service or medical social work. To receive home care coverage, Medicare and most private insurance plans require that you are homebound (unable to leave your home due to your medical condition). Home care is available through Grand View’s Home Care Department.

Grand View Hospice staff provides home health services and support to individuals who have been diagnosed with a terminal disease or are living with a life-threatening illness. Staff have expertise in pain and symptom management, provide quality of life; comfort and support services to patients and their families. Services include nursing, social work, home health aides, chaplain, bereavement, complementary therapies and volunteers. Hospice is covered by Medicare and most private health plans. Care will be provided regardless of ability to pay.

Medical Equipment
Your case manager can help you obtain necessary medical equipment, such as home infusion (IV), wheelchairs, walkers, hospital beds or oxygen.

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

Expectant Mothers, Infants & Children
Many services are specifically designed to meet the special needs of expectant mothers and their children. Your case manager will inform you about these services, such as home health, medical equipment and referrals to county and community agencies specializing in pregnancy support and children and youth programs.

Healthy Beginnings Plus
Healthy Beginnings Plus, a program available through Grand View Hospital, provides care during pregnancy for low income women at no cost to the patient. For more information, call 215-453-4077.

Case Management Services after You Leave the Hospital
Grand View Hopsital’s 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 the necessary forms.