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Chuck Bongiovanni

2018 CSA Conference


Chuck Bongiovanni, MSW, MBA, CSA, CFE




Is Patient Choice Becoming a Pre-Existing Condition; Assisted Living, Homecare Options

The Supreme Court’s ruling in the 1999 Olmstead Decision established that acute-care patients must be offered the “Least Restrictive Environment” in the post-acute that can support a safe discharge including communities services.  The Patient Self-Determination Act of 1990 established a guarantee that patients had the right to make decisions about their own medical care, and to ensure that these rights were communicated to them by their attending health care providers.     

The culmination of the Olmstead Decision and the Patient Self-Determination Act created the practice of the now familiar term, “Patient Choice.”  The practice of Patient Choice is exhibited by offering all medically appropriate patients the right to choose the between the “Least Restrictive Environments” including private pay options, which can support a safe discharge, regardless of the patient’s covered benefits or the physician's or case manager’s perception of the patient’s ability to afford such services.  Used correctly, providers can increase Patient Satisfaction, document Patient Choice and decrease Medicare Spending Per Beneficiary Measures. 

There has been many myths about what Patient Choice really is.  In the hospital and post-acute setting, folklore has been the rule of the land.  It has not caught up to modern healthcare and the goals of quality and financially efficient care. 

Many case managers and physicians should be appraised of alternative care settings that are available that are outside of the traditional continuum of care.  Home Care and Assisted Living are two care alternatives to the high Medicare spending that occurs in an SNF.

Keeping older adults in a traditional homelike environment rather than an institutional setting encourages wellness and healing and can reduce the financial burden of an exhausted healthcare system.  Knowing when these alternatives are options is the next big play in the acute and post-acute space.

Many times it begins with the Certified Senior Advisor as an advocate for all involved.  Learn what Patient Choice really is and how it has been taken away from virtually every patient in many healthcare settings. Learn how to be the connector between families and healthcare providers to the Least Restrictive Environments that are available for older adults after hospitalization.

Learning Objectives

  1. Attendees will have a deep understanding of what Patient Choice really is.
  2. Attendees will learn how to broaden clients and caregivers options outside of the typical healthcare pathway.
  3. Attendees will debunk the myths of what Patient Choice has been viewed for many years.

About Chuck

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