March 24, 2018

Teresa Williams: Taking Control of Home Modifications

By Teresa Williams, MSW, LCSW, Chief Executive Officer, HomeCare Connect

Teresa WilliamsHome modifications can mean the difference between an injured worker living safely at home among familiar surroundings and staying in a hospital, rehabilitation center or skilled nursing facility. They create a safe environment for the injured worker and the family and help seriously injured people achieve greater mobility and independence. A wheelchair-accessible bathroom can make the difference between being able to bathe and being bathed.

Major home modifications can run into tens of thousands of dollars, $100,000 or more – and that’s when things go well. Anyone who has lived through a home renovation knows the stress that comes from no-show workers, scope creep, incompetent contractors, and poor construction. When an injured worker’s safety is at risk and the tab is running at a rehab center or extended stay hotel, the stakes are even higher.

Plus, home mods can be difficult to manage. How can you tell if a proposed modification is right for the claim? How do you know if the contractor will do the job well and if the price is fair? Are workers showing up? No wonder some claims managers want to run and hide when they receive a request for a home modification.

It helps to start with a clear view of the home and any construction barriers to proposed modifications. While traveling to the home isn’t usually practical, today’s telehealth technology makes virtual home tours with the contractor and clinician possible.

Home modifications are highly specialized, involving several clinicians, a contractor and subcontractors as well as the injured worker, their family, and other stakeholders on the claim. Having an experienced and proactive home modification partner makes the process easier, more efficient, cost effective, and it ensures a quality product. So, what qualities should this partner have?

It seems obvious, but it’s important to use a company that knows how to modify homes to accommodate the disabilities of injured workers. Not all do. Some overbuild and others take a generic approach, automatically widening all doors, lowering light switches, and installing ramps. This is a costly, inefficient way to go.

Your home mod company should make sure that modifications are customized to the injured worker’s condition and capabilities and that only the truly necessary changes are made. This requires a solid understanding of home healthcare delivery and durable medical equipment (DME) and how they affect home modifications. Sometimes, DME can replace a portion of the modification project, i.e., using a narrow wheelchair could eliminate the need to widen several doors.

Your partner needs to be able to coordinate all aspects, from selecting contractors and clinicians, scheduling home visits and teleconferences, and overseeing the preparation of a home/patient evaluation report and ultimately the construction project itself. Ideally, the partner has a national network of licensed contractors that are certified through the Americans with Disability Act and that have home modification expertise with an understanding of the workers’ comp process. It is also good to have an experienced, licensed general contractor available for peer-to-peer consultations to help solve any construction problems and answer questions.

Evaluation & Estimate
The first step is a patient/home evaluation conducted by a licensed, ADA-certified contractor and an occupational therapist or nurse case manager who is well versed in home modifications. These professionals visit the home and prepare a detailed evaluation that recommends specific changes to address functionality, accessibility and safety. This home visit is a good time for the claims manager to join the contractor and clinician via teleconference to see the home, discuss options and ask questions in real time. Sometimes it’s hard to understand the costs if you can’t see the issues, and photographs aren’t always enough.

The clinician uses physician orders and clinical findings from the rehab center or hospital to determine the injured worker’s current capacities in relation to the home. Can she go up a flight of stairs or bathe herself? Transfer from a wheelchair? The clinician also considers what modifications would provide greater function or independence, such as whether a retrofitted kitchen would allow the patient to cook meals.

The contractor concentrates on the home’s structure and whether it can handle renovations. Can a ramp be installed safely? Can the ceiling bear the weight of a lift? Some older homes and some mobile homes cannot support extensive modifications, and the evaluation should give the claims manager enough detail to determine whether it is better to buy another home that requires fewer modifications. It happens. In one case, the estimate came in at $130,000 and the property value in the home was only $80,000, prompting the claims team to buy a different home that needed fewer modifications.
The patient/home evaluation report should include visual documentation and measurements, and it should specify exactly how far cabinets should be lowered and how wide door openings need to be. The evaluation should also demonstrate that recommended changes are appropriate and target certain outcomes. Claims managers should feel confident that all the recommended modifications address functional status, medical condition and accessibility barriers and that the most cost-effective solution is applied.

Coordination & Communication
Your partner should assign a project manager who will track the progress, adjust construction schedules and keep you apprised of developments. Knowing what is going on, why a delay occurred, and learning about any unexpected obstacles, such as the discovery of asbestos, as soon as possible helps you keep the claim on track and gives you time to adjust reserves.

Consider requesting weekly updates. They don’t have to be long and involved; they simply need to highlight the projects that were completed that week (doors widened in three rooms, ramp installed in rear of house), problems that arose, and projects planned for the next week. Frequent updates have the added benefit of keeping the contractors and subcontractors accountable.

Claims managers should consider taking another virtual walkthrough midway through the project to monitor progress, and definitely a final one when the work is complete. Tag along when the contractor takes family members on a “punch-list” walkthrough to ensure their satisfaction with the work and identify any areas needing touch-ups. Visual documentation of the final walkthrough is useful in cases where damage occurs down the road.

Home modifications can be complicated and costly. There are a lot of moving parts and different players and skill sets involved, and many things can go wrong and cause delays. It pays to work with experienced experts who understand the clinical as well as construction aspects and can ensure that modifications address functional status, medical condition and accessibility barriers. The real payoff, though, comes from knowing the injured worker can leave a rehab facility to continue recovering at home and to ultimately gain the greatest level of independence possible.

About Teresa Williams
The Chief Executive Officer of HomeCare Connect, Teresa Williams oversees day-to-day operations and provides hands-on experience in clinical oversight of the company’s home health, durable medical equipment and home modification services. Williams developed the company’s comprehensive national home health provider network and its home referral network.

Before co-founding Home Care Connect in 2011, she was a partner in a Medicare Set-Asides company. Previously she worked for 18 years in psychiatric settings in hospitals, both in management and counseling roles.

A Licensed Clinical Social Worker, Williams earned her Bachelors of Sociology degree from Georgia Southern University in Statesboro, Georgia and a master’s degree in Social Work (MSW) from Florida State University in Tallahassee.

About HomeCare Connect
Specializing in catastrophic cases, HomeCare Connect focuses exclusively on managing the quality and cost of home health, durable medical equipment and supplies and home modifications for workers’ compensation payers. With more than 17,000 contracted network providers, its services include nursing, home infusion, respiratory therapy, speech and occupational therapy, prosthetics and orthotics, and the coordination of DME and supplies along with managing home modifications. HomeCare Connect’s partners consolidated their 20-plus years of workers’ compensation experience into offerings and service standards that ensure that injured workers receive excellent care in the fastest time frames at the most affordable prices. HomeCare Connect guarantees response to referrals within two hours and the delivery of an initial medical summary within two days. Listed among the fastest growing, privately held companies in the Orlando, Florida region, HomeCare Connect serves clients nationally and can be reached at or 855-223-2228.

HomeCare Connect is a WorkCompWire ad partner.
This is not a paid placement.

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