Care Management
Our team of care managers and social workers is available throughout Stamford Hospital to assist you and your family with care coordination and discharge planning. We also assist with medical, psychological, and social issues related to illness or injury. We work closely with your physician and can help answer any questions. Together, our goal is to accurately assess patients for risk factors that would inhibit safe and speedy recovery and a return to normal life.
Care Management Services
- Home services
- Hospice care
- Skilled nursing
- Rehabilitation
- Home health aides, equipment and transportation
Whenever possible, we will attempt to arrange coverage by insurance plans. We can also provide information on non-covered services such as private duty aides and transportation. Your case manager will also discuss with you your admission status of Same Day Care, Observation, or Inpatient and what that will mean in regards to your discharge plan.
Social Work Services
- Assist with counseling
- Refer patients and families to community support groups
- Help with crisis intervention
- Provide community resources and outreach for a wide range of non-medical problems that present obstacles to health and healing, such as:
- A limited community support system
- Domestic abuse
- Frailty
- Lack of financial resources
- Poor judgment and decision making
- Transfer patients as needed to other facilities such as sub-acute or acute rehabilitation, and help guide them on the financial obligations involved
Following a personal assessment, social workers gather available resources on care options as well as public and private entitlement programs for the patient. Then they will work closely with the patient’s care team to decide what their next steps should be after discharge from the hospital.