CASE MANAGEMENT

BETTER TECHNOLOGY FOR BETTER HEALTHCARE

At the Governor Juan F. Luis Hospital & Medical Center (JFL), the nurses, doctors and other members of the interdisciplinary team work together to manage your recovery. Coordinating their efforts is the case manager, who “works behind the scenes” to make sure everything goes according to plan.

MEETING YOUR CASE MANAGER

Shortly after being admitted you will have the pleasure of meeting your case manager. Your case manager will be available to you and your family throughout your hospital admission. A case manager can be nurses, social workers or other healthcare professionals. If you would like to see a case manager and one has not visited, please call the Case Management Department.

YOUR CASE MANAGER…

COORDINATES CARE WITHIN THE HOSPITAL

As a patient admitted to the hospital, you may receive different services, such as tests, evaluations and treatments. Your case manager coordinates your care so that a collaborative approach is taken to ensure your health and comfort. Case managers take the lead in ensuring all healthcare disciplines meet on a regular basis to discuss your progress and discharge plan.

HELPS YOU MAKE DECISIONS REGARDING YOUR CARE

Your case manager will explain your available options and will help you to understand the healthcare system. In those instances where a patient and family are indecisive about the plan of care, Family Care Conferences will be held with the patient/family representative and an interdisciplinary team. During this conference, the JFLH interdisciplinary team will listen to any concerns you may have while assisting you to develop a plan of care in preparation for a safe discharge. We will ask you to think about your healthcare goals, doctor’s instructions, support persons, follow up care, available resources, and insurance coverage.

WORKS WITH YOUR INSURANCE PROVIDER

Your case manager works with your insurance provider and physician collaboratively to ensure the services you require are covered. Types of insurance include Medicare, Medicaid, veterans and private insurances, such as CIGNA and Blue Cross/Blue Shield. Your case manager coordinates health insurance benefits and obtains approvals while you’re in the hospital and arranges for your discharge.

ARRANGES CARE FOR WHEN YOU LEAVE THE HOSPITAL

Your doctor will decide when it is safe for you to leave the hospital and your case manager will coordinate the services needed after discharge. If you are not going home, you will be transferred to an acute care facility, rehabilitation center, skilled nursing center, or assisted living facility. If you are going home, your case manager can arrange for medical equipment, home health, hospice, transportation and other healthcare services in your home. Remaining in the hospital until an opening arises is not an option. Your insurance will not pay for you to remain in the hospital beyond the discharge date once you are equipped for discharge.

SERVICES WE CONSIDER WHEN PLANNING YOUR DISCHARGE

ISLAND TRANSFER

In instances where the care you require cannot be provided at the Governor Juan F. Luis Hospital & Medical Center, an order to transfer will be written by your physician. During this process, the physician will inform you of the need for off island services at the nearest facility and a case manager will facilitate the process by collaborating with the receiving facility, air ambulance provider and your insurance provider to expedite the process.

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 assist you.

SKILLED NURSING AND ASSISTED LIVING (PERSONAL CARE) FACILITIES

We will give you 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. 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 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 insurance questions.

HOME HEALTH CARE

Your insurance may cover healthcare services in your home. Typically, services provided are dependent upon your needs and the agency will make a determination. 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 who have been 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 a wheelchair, walker, hospital bed or oxygen depending on your insurance, condition or prognosis.

REFERRAL TO GOVERNMENT AND COMMUNITY RESOURCES

Your case manager will provide you with a resource list and will submit referrals to programs; you may qualify for such as Meals on Wheels, homemaker services and medical assistance. Your case manager can inform you of these services and can send in referrals so that you can receive assistance.

WHILE YOU ARE AT THE GOVERNOR JUAN F. LUIS HOSPITAL & MEDICAL CENTER

Case managers work seven days a week from 8:00 am to 5:00 pm. In emergencies, contact the operator and ask to speak with the case manager. Our goal is to help you leave the hospital in a timely manner. 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 means of transportation from the hospital to home so services can be pre-arranged.

AFTER YOU ARE DISCHARGED

Case management services are available after you leave the hospital. The discharge navigator will contact you after discharge within 72 hours and will follow up regarding any concerns you may have and 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. For assistance, please contact the Case Management Department.