Standards governing the practice of case management were first published in 1995 by the Case Management Society of America (CMSA). The standards were revised for the first time in 2002 and again in 2010. This is the fifth in a series of articles about the legal and ethical implications of the standards revised in 2010.
With regard to ethics, the revised standards provide that:
Case managers should behave and practice ethically, adhering to the tenets of the code of ethics that underlies his/her professional credential (e.g. nursing, social work, rehabilitation counseling, etc.).
Awareness of the five basic ethical principles and how they are applied: beneficence (to do good), nonmalfeasance (to do no harm), autonomy (to respect individuals’ rights to make their own decisions), justice (to treat others fairly) and fidelity (to follow-through and to keep promises).
Recognition that a case manager’s primary obligation is to his/her clients.
Maintenance of respectful relationships with coworkers, employers and other professionals.
Recognition that laws, rules, policies, insurance benefits, and regulations are sometimes in conflict with ethical principles. In such situations, case managers are bound to address such conflicts to the best of their abilities and/or seek appropriate consultation.
Case managers/discharge planners have a special obligation with regard to the ethical principle of autonomy when patients are ready to exercise their rights to choose post-acute providers. The ethical principle of autonomy requires case managers/discharge planners to provide information to patients so that they can make decisions for themselves and act on those decisions.
Applying this ethical principle to the process of discharge planning from hospitals, it is clear that applicable statutes and regulations require case managers/discharge planners to present lists of skilled nursing facilities (SNF’s) and home health agencies (HHA’s) to patients so that they can make autonomous choices. Hospitals are also likely required to present lists of hospices to patients.
A “neutral presentation” of the list that recognizes patients’ right to autonomy means that discharge planners/case managers take the list described above to patients’ rooms and say something like the following (and nothing else that may persuade patients to choose particular agencies): “You have the right to choose the provider that you would like to provide services to you. Here is a list of providers that render services in the area in which you reside.”
If, in response, patients choose providers, then case managers/discharge planners may not try to dissuade them or make negative comments about their choices. The only response to patients who make choices from case managers/discharge planners must be either “Yes, Ma’am” or “Yes, Sir.”
If patients say they cannot choose, case managers/discharge planners must assist them to do so. Case managers/discharge planners, however, do not ever make choices for patients. Instead, case managers/discharge planners may help patients to choose by saying something like the following:
– “As you can see from the list, our hospital owns this hospice. Perhaps you would like to choose this one.”
– “Our hospital has a preferred provider relationship with this provider. Perhaps you would like to choose this one.”
– “This provider has a specialty program in orthopedics, which will be the focus of the services you need, so perhaps you would like to choose it.”
Patients are likely to adopt the suggestions of case managers/discharge planners under the circumstances. There is a clear difference, however, between choosing for patients, which case managers/discharge planners cannot do, and assisting patients with making informed choices. Discharge planners/case managers must never lose sight of the fact that patients are in the drivers’ seats. Patients’ choices “trump!”
It may be helpful to compare the process of choosing post-acute providers with obtaining informed consent from patients for surgery. If patients with mental capacity are unwilling or unsure about giving consent, case managers/discharge planners cannot simply choose for them!
As evidenced from the above standards, case managers are also required to maintain respectful relationships with co-workers, employers and other professionals. This requirement clearly applies to providers to whom case managers make referrals. Anecdotal accounts of the treatment of providers by case managers in positions to make referrals to post-acute providers are difficult to hear. Such conduct clearly violates applicable national standards of care described above.
Stay tuned for more about revised national standards of care.
©2012 Elizabeth E. Hogue, Esq. All rights reserved.