The HeartBeat of Case Management: Dying to Get Home
Peter Moran RN, BC, BSN, MS, CCM

$3.95 		Professional Case Management
October 2012 
Volume 17  Number 5
Pages 239 - 240
 
  PDF Version Available!

ABSTRACT
I recently returned home from a hospital case management national conference. More than 20 years ago, when I first started working in case management, we were talking about capitation and diagnostic related groups; today's buzz words are accountable care organizations and medical homes. Sessions discussed observation status, the uninsured and underinsured, ways to manage high-risk, high-cost populations and innovative programs that, in many ways, are similar to ideas I remember from long ago. However, just when I thought I have "been-there-done-that," situations arise in my practice that make me pause, and remind me why I am a case manager and why I continue to do the work that I do. It doesn't matter if the topic is old, new, or an evolution of what once was; we do what we do because we have the heart of a case manager.I recently completed a 6-month tour on the inpatient medical oncology unit and had the pleasure of meeting Richard and his partner, Sarah. Richard was admitted to the unit with metastatic cancer with metastases to the brain, spinal cord, and bone. He was admitted with delirium, intractable pain, and a new pulmonary embolism. They lived on a little island off Puerto Rico and Richard's one final wish was to return home. Unfortunately, he wasn't able to tolerate systemic narcotics, as they made him more confused and agitated. He definitely could have qualified for general inpatient hospice level of care, except that was not his dying wish.The multidisciplinary team worked to make this happen, even though most of us thought he would never be well enough to get on a plane. In addition, finances were an issue as an air ambulance was cost prohibitive and they could not afford the low-molecular-weight heparin he required. The pain physician trialed an intrathecal pump and his delirium improved to the point he was ambulatory, but still confused. I was able to locate a hospice in Puerto Rico that did go his small island, but was told the nurses get out there as

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