Hospital to HomeAdvocating for Clients

Health & Economic NeedsJoan Park RN MHSc

President, National Case Management Network of CanadaCase Manager, St. Michael’s Hospital

National Case Management Network of Canada 2006

Non-profit federally incorporated

Mandateadvance excellence and professionalism among providers of Case Management

15 sectors

Standards of Practice 2009

CanMEDS Case Management Roles Framework 2012

Case Management is a collaborative, client-driven process for the provision of quality health

and support services through the effective and efficient use of resources

supports the clients achievement of safe, realistic and reasonable goals within a complex health, social and fiscal environment

Canadian Standards of Practice for Case Management 2009

Principles Case Management:

Supports clients rightsIs purposefulIs collaborativeSupports accountabilityStrives for cultural competence

Canadian Standards of Practice for Case Management 2009

CanMEDS Roles Framework Case Management

Communicator

Collaborator

Navigator

Manager

Advocate

Professional

Navigator Definition

Case managers work with clients and their health and social networks to identify and address barriers to holistic care (Draft Dec 2011)

Navigator Key Competencies

Case Managers are able to:Connect clients to services, ensuring that clients are treated respectfully; Follow clients through services that they are not naturally ‘eligible’ for and through a journey where they need to connect with two or more systems of care (e.g. health and cultural; or health and economic)

Advocate Definition

Case Managers, in partnership with their clients, responsibly use their expertise and influence to advance the health and well being of individual clients, communities and populations (Draft Dec 2011)

Advocate Key Competencies

Case Managers are able to:Identify health, social, occupational, environmental, and economic needs;Identify barriers to access and gaps in service;Recognize and balance competing interests between communities served and other populations;Within the boundaries of their role, work toward needed changes in policies, structures, procedures, organizational culture, or resource distribution that would correct barriers to access and gaps in service.

Hospital to HomeHealth and Economic Needs Food

Housing

Health Care

Funding Options OHIP

Community Care Access Centres

Community Support Agencies

Ontario Works

Ontario Disability Support Program

Interim Federal Health

First Nations, Inuit and Aboriginal Health

Private Insurance

Private Health Care Providers

Long Term Disability

Church Community

Ethnic Community

Charity

OHIP Ministry of Health and Long Term Care

Wide range of medically necessary services

Most Ontario health benefits are covered across Canada

Ontario Drug Benefit If you are a senior

On the first day of the month after turning 65 y o, take your prescription and health card to your pharmacy. Tell the pharmacist that you are now eligible for the ODB program. Depending on income, you might be able to pay a lower payment per prescription through the Seniors Co-Payment Program

If drugs costs are high relative to your incomeTrillium Drug Program

If you live in a Long-Term Care home or a Home for Special Care, or you are enrolled in the Home Care system: Talk to Community Care Access Centres

If you receive social assistanceTalk to Ministry of Community and Social Services

Community Care Access Centres Ministry of Health and Long Term Care

Help define needs and situation

Help determine eligibility for government funded home care services

Help locates providers

Help apply for care

Provide information on available financial subsidies

Community Support Services Community Support Services are either non-profit corporations or private

companies

Help to maintain safety and independence while living at home

Services are delivered either in home or in different locations around the community

Security checks, transportation, meal services, caregiver respite, home help, supportive housing

Ontario Works Ministry of Community and Social Services

Need money right away to help pay for food and shelter, and be willing to take part in activities that will help you find a job

Financial assistanceto help cover the costs of basic needs (e.g. food) and housing costs

Employment assistanceto help prepare for and find a job

Additional health benefits for self and family

Ontario Works Additional Health Benefits Prescription Drug and dental coverage

Vision Care – glasses/exams

Diabetic or surgical supplies and dressings

Travel and Transportation for Medical Purposes

Assistive Devices – remaining 25%Cost of assessment for AD

Ontario WorksAdditional Employment Benefits Employment Assistance Activities Expenses

Child care costs

FTE Benefitclothing or uniforms safety shoes or work boots tools and special equipment transportation licensing or professional fees

Extended Employment Health Benefit

Ontario WorksOther Benefits Transition Child Benefit

Community Start Up and Maintenance Benefityou are moving to a permanent residence you are leaving an institution you are behind with your rent payment and are either being evicted or have been evicted, or you are behind with your utility or heating payment and it has been or will be disconnected

Guide Dog Benefit

Ontario Disability Support Program Ministry of Community and Social Services

Income Supporthelps people with disabilities who are in financial need pay for living expenses, like food and housing

Employment Supportshelps people with disabilities who can and want to work prepare for and find a job.

Assistive Devices Program Ministry of Health and Long Term Care

75% funding to residents who have long-term physical disabilities and to provide access to personalized assistive devices appropriate for the individual’s basic needs

prostheses; wheelchairs/mobility aids and specialized seating systems; enteral feeding supplies; monitors and test strips for insulin-dependent diabetics; insulin pumps and supplies for children; hearing aids; respiratory equipment; orthoses; visual and communication aids; oxygen and oxygen delivery equipment

Grants are provided for ostomy supplies, breast prostheses and for needles and syringes for insulin-dependent seniors

Interim Federal Health Program Citizenship and Immigration Canada

Temporary health insurance to refugees, protected persons and refugee claimants, as well as to their dependants, in Canada who are not yet covered by a provincial or territorial health insurance plan

First Nations, Inuit and Aboriginal Health Health Canada

Non-Insured Health BenefitsLimited range of medically necessary health-related goods and services to which these individuals are not entitled through other plans and programDrugs, dental care, vision care, medical supplies, equipment, short term crisis intervention mental health counselling, and medical transportation

Veterans Affairs Canada Programs

Professional CounsellingDisabilityFamily SupportHealth BenefitsRehabilitation Treatment BenefitsIndependence

Summary Case Managers advocate for the health, social, occupational, environmental,

and economic needs of clients

A miscellany of public and private options exist to meet these needs

One size does not fit all

Case Managers navigate clients through 2 systems – health and economic

GOAL to exhaust public funding options prior to private funding options prior to considering “treatment loan” in order to maximize opportunity for interest recovery at settlement