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assessment, clinical judgment, discharge planning, federal regulations, patient choice, patient rights, post-acute levels of care



  1. Birmingham, Jackie BSN, MS, RN, CMAC


Purpose/objective: To describe steps in offering a patient a choice of post-acute care providers during the discharge planning process that reflects the case management principles and compliance to regulations related to patient's rights to choice.


Primary practice setting(s): Nurses and social workers, particularly those who work in case management or care coordination settings; staff nurses who do discharge planning in acute care settings; and liaison or intake coordinators from post-acute care providers such as skilled nursing facilities and home health agencies who are involved in offering choice to patients during the discharge process; payer-based case managers, particularly those in Medicare Advantage plans.


Findings/conclusion: Patient choice is a right, including during the discharge planning process. Offering choice of available and appropriate options is a case management responsibility not only because of the federal regulations mandating choice but also because it is a reflection of advocacy for patients and families. The work leading up to preparing options from which a patient can choose closely follows the Case Management Standards of Practice (Case Management Society of America, 2002). Follow the process and providing choice becomes a safe and effective part of the transition of care. Note that this is not intended to be legal advice. Consult your own compliance officer for application of the information to your own setting. Every effort has been made to use the most current information.


Implications for care management practice:


1. Patient's right to choice is based on the concept of choosing between appropriate and available options and is dependent on the professional skills and judgment of nurses and social workers, whose responsibilities include the process of discharge planning.


2. Offering patient choice is a function of advocating for patients by ensuring that they receive care needed in the appropriate setting at the appropriate time.


3. More study is needed on the influence of executive cognitive function assessment on patient choice.


4. Investing in software programs that assist in determining availability of appropriate post-acute care providers for individual patients is essential for efficient and safe discharge of patients.