Case Management

Answer the following questions to this case study Using the case study, assume the case manager role and apply the role to the circumstances of this client. Refer back to part 1 of this week’s assignments for guidance.   What would you as the case manager do with and for Emma and her family? Mrs. Emma W. is an 84 year old widow who retired at age 65 from a part-time job in the housekeeping department of a local hospital to care for her granddaughter and great-grandchild. She has a history of obesity and hypertension. She lives alone in a low income housing project. Her only daughter lives out of state and has no contact with Emma or her daughter Emilee and the grandchild. Emma’s only income is $740 per month from her husband’s Social Security, and Medicare is her only health insurance. Her monthly living expenses (rent, utilities, phone, etc.) amount to $500. Her health is poor and she reluctantly went to a physician who diagnosed her with uncontrolled hypertension, osteoporosis and chronic renal disease and prescribed her medications. The total cost for her medications will exceed $350 per month. A Registered Dietician gives her detailed diet instructions. The cost of the foods far exceeds her usual food budget. She cannot afford her medications or food and her health further deteriorates. Mrs. W is hospitalized with increasing fatigue, shortness of breath, uncontrolled hypertension, 2-3+ generalized edema, elevated BUN and creatinine, low HH. The HCP informs her that she needs dialysis, at least 3 days/week. Emma refuses, stating “I won’t be tied to a machine like my sister for the rest of my life.” She wants to go home, but her granddaughter, Emilee, is concerned that she cannot care for her in her home and hold down her waitress job—not to mention care for her own daughter and manage her own home. Emma has no advance directives and no POA. Mrs. W. is aware of her lack of financial resources and deteriorating health status, but doesn’t know what to do to help improve the situation. 1. What interventions would have helped to prevent this woman’s deterioration in health status? 2. As a health care professional who is aware of this woman’s circumstances, what steps could you take to help her now? 3. You discuss possible nursing home admission with Mrs.W. (Remember that Medicare does not pay for custodial care.) If she will not agree to be admitted, what steps do you think you will need to take to overcome her problems? 4.  Demonstrate the interdisciplinary members that may need to be involved in the client’s care. 5.  Demonstrate the responsibilities of each interdisciplinary member. 6.  Provide a schedule of how the team will effectively collaborate the client’s care. 7. You also discuss Medicaid with Mrs. W. Describe what measures you would need to take to help her access the system. What limitations might you encounter?