By Ivan Castro, MD, Medical Director, HomeCare Connect
Traumatic Brain Injury (TBI) is caused by an injury to the head that disrupts the normal function of the brain, and there is a wide range of severity. An individual with a brain injury has a very unpredictable sequence of recovery as no two TBIs are identical. Recovery can be a lifelong journey with its success dependent on learning as much as possible about TBI.
Many injured workers with TBI move home from a hospital or rehabilitation center to continue their recovery. Being in familiar surroundings can provide a greater sense of independence and help them regain physical and mental functions. Yet transitioning an injured worker with TBI from a hospital/rehabilitation center to home can overwhelming as well as exciting for injured workers and their families/caregivers.
Once a decision has been made to continue recovery at home, it is imperative that the discharge planner begin the transition weeks in advance to ensure a smooth, seamless transition. The severity of head injury will determine the resources needed to provide a safe and secure home environment. These resources may consist of home safety evaluation, home modifications, durable medical equipment (DME), and home health services, including skilled therapies.
Once the severity of the TBI and functional capacity of the injured worker have been determined, the next step is to complete a home safety evaluation. The goal is to promote increased independence and health while preventing further injury. This is typically conducted by an Occupational Therapist (OT), who assesses the injured worker’s living environment and support system in relation to his/her physical, mental, and psychosocial health.
The evaluation’s report contains plan of care to maximize injured workers’ independence within the home and in the community. Evaluation results are shared with the injured worker’s treating physician to maintain an interdisciplinary team approach of care.
The health safety evaluation considers the person’s ability to independently perform the basic activities of daily living such as dressing, bathing, meal preparation, and medication management. It also identifies any adjustments that need to be made to the environment, including home modifications and durable medical equipment, to accommodate the person’s injuries and maximize independence and safety within the home.
Home modifications are common and often necessary to provide accessibility throughout the home in accordance with the Americans with Disabilities Act (ADA) guidelines. These can range from a ramp into the home door widening, and grab bars to roll-in showers. An example would be an installation of grab bars in the tub and near the toilet for an injured worker who has poor balance and needs extra stability. The OT takes into consideration medical equipment, such as a wheelchair or walker, which the injured worker will need to safely maneuver in the home.
Depending on the severity of the brain injury, the injured worker will present with different degrees of emotional, intellectual and psychological impairments. These may consist of memory loss, poor attention span, inability to reason and difficulty speaking, reading and writing.
The most difficult obstacle for the injured worker and his/her family is associated with the psychological component of TBI. The injured worker may present with mood swings, aggressiveness, lack of patience, impulsivity, confusion, frustration, withdrawn behavior, or depression. It is imperative to have home health providers who are experienced with TBI, as they are tasked with providing a safe and secure environment for the injured worker and family when dealing with the complex nature of the TBI.
Home management may consist of a wide variety of care activities, including assistance with activities of daily living, such as bathing, eating, grooming, and ambulation. Home health services may include nursing, home health aides, personal care services, and therapies such as occupational, physical, and speech therapies. The number of hours per day, and days per week of specified services to be provided will be determined by the registered nurse and/or therapist after the initial evaluation is completed.
Education and early planning with the injured worker and their family is crucial especially when making necessary arrangements that will significantly decrease the stress and frustration that can occur when caring for a loved one with TBI. A family member is the most important part of the injured workers plan of care, as they typically serve as the support system and facilitator by incorporating positive reinforcement. Positive reinforcement helps the recovery process by improving self-esteem and promoting independence. The home health team needs to ensure that the family is properly educated and included in the injured workers’ plan of care. Injured workers thrive in the comfort of familiarity and with the support of their loved ones.
Good planning, education of the injured worker and family members, and having home health providers with expertise in TBI make all the difference in a successful transition to the home.
About Dr. Ivan Castro
As medical director for HomeCare Connect, Ivan D. Castro, MD oversees the company’s clinical programs and staff. He also works directly with treating physicians as needed to obtain the best medical outcomes for injured workers. Certified by the American Board of Internal Medicine, Dr. Castro has been treating workplace injuries and implementing wellness programs for more than 20 years. He is fluent in English and Spanish and maintains a private practice in Winter Park, Florida, near Orlando.
A graduate of Dartmouth College in New Hampshire, he earned his medical degree from the University of Illinois College of Medicine at Peoria in Illinois. Dr. Castro conducted his medical residency at the Alaska Area Native Health Service Mt. Edgecumbe Hospital in Sitka, Alaska and his residency in internal medicine at Kaiser Permanente Medical Center in Santa Clara, California. Orlando Magazine has named him “Top Doctor” in Internal Magazine numerous times, and he is the former chief of staff of the Winter Park Memorial Hospital.
About HomeCare Connect
HomeCare Connect is a national ancillary network focused on workers’ compensation and providing home health, durable medical equipment and home modification services. The privately held company has a clinically driven model — from its 15,000+ credentialed provider network — to its highly experienced clinical staff who coordinate everything related to care, medical supplies and equipment delivered in the home. Services include catastrophic care and home health care along with durable medical equipment, supplies and home modifications. HomeCare Connect ensures the injured worker receives the right care, equipment and supplies from the right providers at the right time.