Case management- Mr. Tan is 62-year-old, was recently admitted to Hospital A, Singapore

Background

Mr. Tan is 62-year-old, was recently admitted to Hospital A, after he fell on the pavement on his way to the food court on 2 June 2019. He sustained a mild concussion with bruises but no fracture. He was discharged after 5 days.

Two weeks later, on 22 June 2019, Mr Tan had acute back pain and was admitted to Hospital

B’s emergency department, as he was unable to walk. In the hospital wards, he was treated with lumbar corset and analgesics. He was discharged on 24 June 2019.

Hospital B has a programme which screens for high-risk elderly patients upon admission. Case managers are then assigned to Mr Tan, as there is indication of functional decline since his fall.

Mr Tan lives alone in a 3-room flat, widowed with no children. Mr Tan slept on the bed frame without the mattress, as he mentioned that the mattress hurt his back. In the first home visit with Mr Tan on 25 June 2019, you also discovered that his medications were all over the house, in different bags and storage boxes. He was unclear about his follow-up appointments and which hospital it was in. Mr Tan was concerned about the hospital bills and does not have a phone line to contact home care services. Mr Tan tells you he wants to stay at home.

Today, 27 June 2019, Mr Tan is once again hospitalized through the emergency department of Hospital B. He had yet another fall while trying to navigate his way home.

As a Case Manager in charge of transitional care from Hospital B,

• Discuss the case management process to be used in working with Mr Tan.
• Utilize Eric Coleman’s Four Pillars Model to cover his medical, financial and social needs.