I only stay in 4-5 Star Nursing Homes?

Not too long ago, one of the doctors that I work sent me a message asking me to find a 4-star nursing home/skilled nursing facility (SNF) for a patient. When I saw it, all I could do was to laugh incredulously. A 4-star SNF?, I thought. Does that mean one with a concierge and a flat screen TV? Seriously, I thought the doctor was either pulling my leg or ready for a vacation. So before I actually said anything to him about it, I did a little research. What I found made me privately eat a little crow. Actually the US Government, through Medicare, began to rate SNFs, on a scale from 1-5 stars, since December 2008. Apparently this update isn't widely known, but a patient's family had asked the doctor about it and this is how the subject came to me. This again emphasizes the benefits of patients and families being their own advocate and becoming educated about what is out there.

We are all familiar with hotel star ratings. Well, because of that familiarity, Medicare decided to use the same rating system with SNFs. What you need to know though, is that the rating criteria is very different than that of a hotel. Instead of a rating based on things like on-site restaurant, free wi-fi, or a swimming pool, the SNFs are rated on things like State health inspection results, staffing, and quality measures such as if residents are given their flu shots or how many are underweight, etc. The 5-star rating system is broken down into the following:

Nursing homes are rated overall and on health inspections, nursing home staffing and quality measures. More stars are better.*

Much Above Avg.
Above Avg.
Average
Below Avg.
Much Below Avg.

You can find a SNFs rating, and other detailed information about it, at Medicare's Nursing Home Compare website. www.medicare.gov/nhcompare/ Although this system is very helpful to the consumer looking for a facility, it doesn't take the place of touring the facility, talking to the administrator as well as the staff and other residents. Personal recommendations are also helpful.

I learn from my patients all of the time. I appreciated the one that made me aware of this. Hey, pass it on to others that you know that might find it helpful. It is information that is difficult to find elsewhere. Every administrator will tell you that their facility is the best. Now you will really know.

Knowledge is power.

* star chart taken from medicare.gov

What is a Case Manager?

You would think that would be an easy question. Maybe a google search would help. It can't be that complicated, right? Well, actually you could find many different definitions of a Case Manager, depending on the source. Here are a few:

Case management is an area of practice within several healthcare professions. Most case managers are nurses or social workers.
en.wikipedia.org/wiki/Case_manager

An experienced professional (eg, nurse, doctor, or social worker) who works with patients, providers and insurers to coordinate all services deemed necessary to provide the patient with a plan of medically necessary and appropriate health care.
www.futurehealth.ucsf.edu/cnetwork/resources/glossary/gloC.html

A professional who serves as a point of contact for an individual with disabilities or a family. This person seeks out and coordinates resources ...
rrtcpbs.fmhi.usf.edu/rrtcpbsweb/glossary.htm

For the sake of conserving bandwith, I only chose a few, there are actually many. Even though a number of the definitions are different, they are all accurate. Maybe it would help if I included a "formal" definition from one of the Case Management professional orginizations:

"Case Management in Hospital/Health Care Systems is a collaborative practice model including patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self determination." American Case Management Association http://www.acmaweb.org/default.asp

Case Managers wear many different hats and there are many sub-specialties. The type of Case Management issues that MyCaseManager will be addressing will also be varied, however, the main focus will be on educating you as a consumer, whether you happen to be a patient, a family member, or friend, my hope is that what you learn here can help prepare you to navigate the maze of US healthcare, and it truly can be a maze. You need to be your own advocate or if your loved one is unable to advocate for themselves, you must have the knowledge that it takes to make sure they receive the care they need and are prepared for illness and recovery. Knowledge is power. I want to give you a heaping dose of power through this blog. I hope you will enjoy it.