By Anita Jovic, RN, BSN, MBA, Vice President of Operations, HomeCare Connect
Experiencing a traumatic brain injury (TBI) can be devastating for the injured worker and their loved ones. Considered one of the most complex types of catastrophic injuries within workers’ compensation, TBI is an injury to the head that disrupts the normal function of the brain and is usually caused by an external or penetrating force to the skull that damages the brain’s tissue. The Center for Disease Control and Prevention (CDC) estimates there were approximately 2.8 million TBI cases with 50,000 deaths in 2013.
A TBI can impact an injured worker’s motor-sensory system, communication skills, and physical or cognitive abilities. It can also cause major personality and behavioral changes that disrupt the whole family. While the severity of the injury obviously affects the extent and timing of recovery, proactive care and rapid response to the injured worker’s needs produce the best outcomes.
Among the most complex catastrophic cases in workers’ compensation, TBIs are disruptive enough without complicating the transition from the 24/7 care of a hospital or rehabilitation center to the home.
Delay of care and major safety risks can occur when an injured worker is discharged without orders for home health services and durable medical equipment (DME). Delayed authorization for these services can cause setbacks and add unnecessary costs to the claim. Every extra day the injured worker stays in a hospital, rehab or skilled nursing center significantly increases the cost to the carrier.
Imagine an injured worker with a TBI being sent home without any care set up. This was the case with a 26-year-old male who was hurt on a construction site when he fell off the roof. He was discharged during a weekend with no services or discharge planning. At one point, the injured worker left his home half-dressed and had wandered a few streets away before a stranger spotted him trying to cross a major intersection. If not for the bystander’s intervention, this injured worker could have been hit by oncoming traffic.
Once he was returned home with no services in place, his wife became frustrated as she had to constantly follow him around to make sure he was safe. Family members are overwhelmed and don’t know where to turn when discharges are mishandled.
Here’s what ought to happen. Discharging home begins with intense and comprehensive preparation to help the injured worker and family adjust to this major lifestyle change and to make sure the home will have the equipment and medical services in place accommodate the injured worker’s specific needs. Usually the hospital or other facility’s discharge planner will have coordinated physical and cognitive evaluations and will collaborate with the home health provider on this process.
For severe TBIs, the home health managed care company should assign an experienced TBI/Catastrophic (CAT) Care nurse to the case. The nurse works closely with the discharge planner to determine the required services, which may include a home safety evaluation, nursing and skilled therapy services, a home modification, and durable medical equipment (DME). Every TBI case is different and the severity of the injury will dictate which resources are necessary. Once a home health evaluation is completed, these recommendations and a plan of care should be discussed with the treating physician.
In complex cases, the TBI CAT Care nurse serves as the point person for everyone involved in the case and communicates with the injured worker and family, carrier/employer, and service providers. The first step is to ensure that the home is safe and appropriate services are in place before the injured worker comes home in order to create an environment that provides safety and security when the injured person comes home and foster their independence as they recover to their new normal.
As the discharge date approaches, the injured worker and family/caregivers should be educated on the injuries and treatment and prepped for transition to home. When an injured worker leaves an environment of 24/7 care and returns home, the family/caregiver experiences enormous changes and stress can come from a plethora of scenarios. Parents and spouses often have to work full time, there are bills to pay, meals to fix, homes to maintain, children to raise—all the things families face every day–compounded with the added pressure of having a loved one who is suddenly and irrevocably changed.
Family caregivers experience a death as the individual they once knew is no longer here and often refer to their loved ones as a stranger in their family member’s body. It is important to provide these families with resources and support groups to help them understand how to cope during these tough times. An efficient transition from the rehab center into the home goes a long way to helping families adjust.
One key to managing a TBI complex claim is delivering information expeditiously, timely and thoroughly to everyone involved in the case. Having nurses and other clinicians with TBI experience is pivotal. It’s important to not let these claims go on auto pilot; they should be reviewed regularly to see if service levels can be adjusted, if a new DME device could reduce nursing care, to make sure physical and living conditions are not deteriorating. CAT TBIs are already catastrophic for the injured worker. Preparation, education, experienced and knowledgeable healthcare providers, and carefully monitoring the cases can mitigate their catastrophic effect on injured workers’ families and payers.
About Anita Jovic
Anita Jovic is the Vice President of Operations for HomeCare Connect, overseeing its clinical operations, including catastrophic care. She also conducts continuing education programs on a variety of home health clinical topics, including wound care, catastrophic care, and clinically driven home modification and durable medical equipment programs.
Anita has more than 24 years of nursing experience, encompassing workers’ compensation, catastrophic care, and home health. Before joining HomeCare Connect in 2015, Anita was responsible for one of the largest workers’ compensation catastrophic care programs in Florida. She previously served as Chief Nursing Officer for a home health agency and as Chief Executive Nursing Officer for a consulting firm that established a respiratory recovery program with several South Florida hospitals. Earlier, Anita was a nurse case manager, a hospice nurse, and a nurse manager for Lexington Cancer Center in Kentucky. She started her nursing career at Orlando Regional Hospital in Florida.
She earned her bachelor’s degree in nursing from Eastern Kentucky University and her Master of Business Administration degree from Nova Southeastern University in South Florida.
About HomeCare Connect
HomeCare Connect is a national ancillary company in workers’ compensation that specializes in home health, catastrophic care, durable medical equipment, home modification services, and prosthetic and orthotic (P&O) services. The privately held company has a clinically driven model — from its 18,000+ credentialed and directly contracted provider network — to its highly experienced clinical staff who coordinate everything related to care, modifications, medical supplies and equipment delivered in the home. HomeCare Connect ensures the injured employee receives the right care, equipment and supplies from the right providers at the right time. The company can be reached at www.homecareconnect.com or 855-223-2228.
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