March 24, 2016

The Case Management Discharge Process


Discharge planning is yet another essential function of case managers, support coordinators and social workers. The discharge process is often met with mixed emotions from case managers. The brief sense of relief of having one less case is usually followed by anxiety knowing at some point you’re going to get another one that may be more difficult than the one you had.
In most cases, discharge means that the client has achieved his or her goals and is no longer in need of services. This is often the case with mental health case management. However, intellectual disability (ID) case management is a little different. ID case management services tend to be long term so discharge from services is usually the result of major events such as a move to another state or city, or a transfer to a nursing facility or an ICFIDD. These facilities have their own case management services and there is no need for additional case management from  community services boards . In addition, Medicaid views this as a duplicate service and will not pay for two case management services. The discharge process is critical to ensuring that your clients have a smooth transition from one service to another.

There are other situations when the client is not compliant with services and chooses to leave on their own. This is sometimes referred as a discharge against medical advice or “AMA” discharge. I haven’t seen this one often in case management but on several occasions while working in the psychiatric hospital (especially on the substance abuse unit).

There are three basic components to the discharge process: linkage, service coordination, and documentation. Of course, the discharge process can vary depending on the agencies policy and procedures.

Linkage                                                                            
During the discharge process, case managers assist with referrals to other agencies. This often includes providing the client and/or the family with a provider list so that they can make informed choices. The linking process may also include educating families about available resources without influencing their choices. Case managers may also provide assistance with setting up and attending tours with families.    

Service Coordination
The service coordination aspect involves contacting new providers and exchanging information. This involves contacting agencies in other states and determining the services that they can offer. The case manager may also provide social history and any other medical or behavioral health information to assist with the transition (with written consent of course). When cases are transferred between neighboring cities, agency directors often coordinate to prevent gaps in services.

Discharge Documentation
As with any other function of case management, documentation is also necessary. A discharge summary is completed detailing the progress on treatment plan goals and reason for discharge. Health, behavioral, and medication changes during the period of case management services are also documented in the discharge summary. Recommendations for ongoing and future services as well as any referrals that were made are also included. After the discharge summary is complete, the case is then closed but the record may remain with the agency for five to ten years depending on the agency’s policy.