Transcript Hospital to Home Advocating for Clients Economic Needs

Hospital to Home
Advocating for Clients
Health & Economic Needs
Joan Park RN MHSc
President, National Case Management Network of Canada
Case Manager, St. Michael’s Hospital
National Case Management Network of Canada
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2006
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Non-profit federally incorporated
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Mandate
advance excellence and professionalism among providers of Case Management
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15 sectors
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Standards of Practice 2009
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CanMEDS Case Management Roles Framework 2012
Case Management
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is a collaborative, client-driven process for the provision of quality health
and support services through the effective and efficient use of resources
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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
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Case Management:
Supports clients rights
Is purposeful
Is collaborative
Supports accountability
Strives for cultural competence
Canadian Standards of Practice for Case Management 2009
CanMEDS Roles Framework
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Case Management
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Communicator
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Collaborator
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Navigator
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Manager
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Advocate
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Professional
Navigator
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Definition
Case managers work with clients and their health and social networks to
identify and address barriers to holistic care (Draft Dec 2011)
Navigator
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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
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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
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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 Home
Health and Economic Needs
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Food
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Housing
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Health Care
Funding Options
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OHIP
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Private Insurance
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Community Care Access Centres
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Private Health Care Providers
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Community Support Agencies
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Long Term Disability
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Ontario Works
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Church Community
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Ontario Disability Support Program
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Ethnic Community
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Interim Federal Health
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Charity
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First Nations, Inuit and Aboriginal
Health
OHIP
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Ministry of Health and Long Term Care
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Wide range of medically necessary services
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Most Ontario health benefits are covered across Canada
Ontario Drug Benefit
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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
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If drugs costs are high relative to your income
Trillium Drug Program
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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
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If you receive social assistance
Talk to Ministry of Community and Social Services
Community Care Access Centres
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Ministry of Health and Long Term Care
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Help define needs and situation
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Help determine eligibility for government funded home care services
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Help locates providers
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Help apply for care
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Provide information on available financial subsidies
Community Support Services
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Community Support Services are either non-profit corporations or private
companies
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Help to maintain safety and independence while living at home
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Services are delivered either in home or in different locations around the
community
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Security checks, transportation, meal services, caregiver respite, home help,
supportive housing
Ontario Works
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Ministry of Community and Social Services
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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
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Financial assistance
to help cover the costs of basic needs (e.g. food) and housing costs
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Employment assistance
to help prepare for and find a job
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Additional health benefits for self and family
Ontario Works
Additional Health Benefits
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Prescription Drug and dental coverage
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Vision Care – glasses/exams
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Diabetic or surgical supplies and dressings
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Travel and Transportation for Medical Purposes
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Assistive Devices – remaining 25%
Cost of assessment for AD
Ontario Works
Additional Employment Benefits
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Employment Assistance Activities Expenses
Child care costs
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FTE Benefit
clothing or uniforms
safety shoes or work boots
tools and special equipment
transportation
licensing or professional fees
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Extended Employment Health Benefit
Ontario Works
Other Benefits
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Transition Child Benefit
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Community Start Up and Maintenance Benefit
you 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
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Guide Dog Benefit
Ontario Disability Support Program
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Ministry of Community and Social Services
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Income Support
helps people with disabilities who are in financial need pay for living
expenses, like food and housing
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Employment Supports
helps people with disabilities who can and want to work prepare for and
find a job.
Assistive Devices Program
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Ministry of Health and Long Term Care
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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
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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
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Grants are provided for ostomy supplies, breast prostheses and for needles and
syringes for insulin-dependent seniors
Interim Federal Health Program
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Citizenship and Immigration Canada
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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
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Health Canada
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Non-Insured Health Benefits
Limited range of medically necessary health-related goods and services to
which these individuals are not entitled through other plans and program
Drugs, dental care, vision care, medical supplies, equipment, short term
crisis intervention mental health counselling, and medical transportation
Veterans Affairs Canada
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Programs
Professional Counselling
Disability
Family Support
Health Benefits
Rehabilitation
Treatment Benefits
Independence
Summary
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Case Managers advocate for the health, social, occupational, environmental,
and economic needs of clients
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A miscellany of public and private options exist to meet these needs
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One size does not fit all
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Case Managers navigate clients through 2 systems – health and economic
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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