Those of us who have years of experience working with catastrophically injured claimants see the disturbing pattern time and time again: The claimant presents to the emergency room with the initial injury and subsequently travels through a fragmented healthcare delivery system that all too often stops woefully short of meeting the claimant’s long-term needs. While naturally there is significant focus on early intervention strategies and medically managing the workers’ compensation aspects of a new CAT claim during the early life-saving and acute phase of the injury, there is dangerously little attention and effort devoted to the coordination of long-term management of these high-risk for failure claimants.
Catastrophically injured claimants are often discharged too soon and/or to the wrong setting, unarmed with the knowledge and insight required to navigate their permanently changed lifelong journey.
Traumatic brain injured claimants, for example, may be discharged home from a hospital or acute inpatient rehabilitation facility only to find themselves and their caregivers unable to cope with the sequelae of the work injury. This puts tremendous strain on the claimant and family, which often has a devastating impact on the recovery process. Although initially, the effects of a brain injury may not be physically apparent, they continuously challenge the claimant on a daily basis. Attention deficits, mood swings, depression, anxiety, anger, PTSD and behavioral challenges are common. If the big picture of brain injury rehabilitation is not addressed from the inception of the claim, these claimants may travel down new catastrophic paths including substance abuse, behavioral crises, misdiagnoses, incarceration, hospital readmissions and eventually, costly lifetime medical and indemnity benefits especially if the claimant experienced the injury at a young age. In other words, claimants get stuck unnecessarily in a detrimental and expensive “vortex of failure.”
Related: Workers’ Compensation: 10 issues to watch for 2017
|How can this “vortex of failure” be stopped?
Challenging the traditional post-acute care delivery model is the key. Catastrophically injured claimants require specialized care and rehabilitation services, which is where the traditional care model often stops, fails or misses the boat. At the outset of a CAT claim, we must begin to think differently about the “step down” process for a catastrophically injured claimant. If we expect these individuals to successfully integrate into their family and community once medically stable, we need to consider moving them from a highly-institutionalized setting (hospital, acute inpatient rehabilitation facility, skilled nursing facility) to a therapeutic residential rehabilitation setting before sending them home. This is a critical point on the post-acute care continuum that can be the vortex breaker.
Related: 9 best practices for return-to-work programs
|Identifying the next step
Insurance payers, case managers, physicians, discharge planners, etc. need to ask these questions before recommending the next “step-down”:
- What additional services will the claimant need in order to function independently?
- How will the injured claimant adapt to normal living, home life and the community?
- Can he/she return to work? - Does the claimant have close family or a caregiver? Will the family be able to cope with the effects of a traumatic brain injury or do they need time, training and support?
These critical questions must be answered and plans should be made to deliver the necessary services and real-life experiences that today are not accounted for in most post-acute care rehabilitation settings.
Related: Top 10 workers’ comp carriers for 2016, as ranked by NAIC
|What should you look for?
- Interdisciplinary and specialized community- integrated residential rehabilitative treatment that will maximize recovery and address long-term needs.
- Family education and participation in the claimant’s rehabilitation program in order to develop the knowledge, skills and advocacy abilities necessary to support the injured individual through a lifetime.
There is a strong correlation between the timing and duration of aggressive rehabilitation and an injured worker’s chances of ever returning to work and a life with purpose. Physical, social and vocational goal-setting by an expert team of rehabilitation clinicians can effectively move the claimant from where they are to where they want to be. We can safely assume that catastrophically injured workers do not want to be stuck in a “vortex of failure.” Let’s break that paradigm and work harder to re-integrate these injured individuals back into our communities.
Lydia Hendrix RN, BSN, MSSL, CRRN is the chief operating officer/division chief executive officer of NeuLife Rehabilitation in Mount Dora, Florida. Hendrix has a B.S. in nursing from Florida State University, and a M.S. in strategic leadership from Mountain State University. She has worked as a surveyor for the National Commission on Accreditation of Rehabilitation Facilities (CARF) and the Florida Department of Health-Brain and Spinal Cord Injury Program. She is also the 2016- 2017 President of the Central Florida Association of Rehabilitation Nurses (CFARN). Hendrix can be contacted via LinkedIn.
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