Q&A: Disruptions in patient communication and decision-making

Q: Case management requires a lot of communication with patients. What happens when communication can’t happen because of a patient’s temporary or permanent condition?

A: If communication with the patient is disrupted, the case manager must determine the reason for the disruption and if communication can be facilitated by some other means. If there is a language barrier or the patient cannot hear, the 1990 Americans With Disabilities Act requires that the hospital provide an interpreter for the patient. If the disruption in communication is due to some other reason, the case manager must determine if the disruption precludes the ability of the patient to participate in decision-making and to give informed consent for discharge planning purposes. In other words, does the patient have the capacity to make his or her own decisions?

If the patient already has an appointed guardian or power of attorney (POA) for healthcare decisions, the guardian or POA is the decision-maker for the patient and therefore the one with whom the case manager should interact, plan, and communicate. Since there can be confusion about who is a legal guardian, the case manager must ask, “Is the guardian someone who has been appointed by the court?” He or she should also ask for a copy of the guardianship document and determine whether the POA form grants medical decision-making, since some POA forms are for financial management.

If there is no appointed guardian or medical POA, the case manager must take measures to determine whether the patient is capable of making his or her own decisions, and, if not, determine who is the appropriate decision-maker on the patient’s behalf.

For more information, see Case Management Patient Communication Toolkit. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.