Social Work and Case Management

Taking care of each person's health is what we do best. And at The University of Kansas Health System, our care extends beyond the bedside. As you and your family members prepare for discharge from the hospital, our discharge planning team makes sure you receive the help you need each step of the way.

Our goal is to ensure your experience is as smooth and seamless as possible.

Our discharge planning team consists of a social worker and a nurse case manager. They are dedicated to helping you and your family members with different types of needs during your hospital stay and through discharge. Please do not hesitate to contact them with any questions.

Physicians, nurses, therapists or other medical professionals may also provide essential care and advice. These dedicated team members will make recommendations for care following hospitalization and help you find the resources to live a healthy life.

You may have further medical or recovery needs once you have been cleared for discharge. During your hospital stay, the discharge planning team will take time to learn about any potential discharge needs you may have, and find answers and options. Possible ongoing care options that may be discussed with you and your family include:

• Long-term acute care (LTAC): This type of facility is considered a step down from the hospital. LTAC facilities specialize in the treatment of complex medical issues.
• Inpatient rehabilitation: This program provides intense, short-term physical, occupational and/or speech therapy for a total of three hours each day. The goal is to help you return home. Please keep in mind that you may still need 24-hour assistance or supervision after discharge.
• Skilled nursing facility: These facilities provide short-term care, including physical, occupational and/or speech therapy. The level of care depends on the patient's ability to participate. This is a less intense program and may be recommended for those who are unable to participate in three hours of therapy each day.
• Long-term care facility: This type of facility provides custodial care for patients who cannot care for themselves.
• Home health: These programs offer skilled, intermittent care and treatment for illness or injury. This may include nursing services and physical, occupational and/or speech therapy. If necessary, social and dietary services may also be provided.
• Outpatient therapy: For people who require further physical, occupational and/or speech therapy, services may be set up with our hospital team or at a location closer to home.
• Hospice: These programs are for patients and families facing progressive, life-limiting illnesses who wish to have care focused on comfort (symptom management; psychosocial, spiritual and practical support) at home or in an inpatient setting. A team of physicians, nurses, aides, social workers and chaplains provides comprehensive care through the final months of life.