By Anita Jovic, RN, BSN, MBA, Vice President Clinical Operations, HomeCare Connect
While the number of workers’ compensation claims for workers who have become seriously ill with COVID-19 are thankfully low, the severity of these claims will be high. These could include workers who contract COVID-19 on the job as well as injured workers exposed to the virus by a caregiver providing services for an earlier workers’ compensation injury. People with catastrophic injuries tend to have compromised immune systems, putting them at an even higher risk of becoming seriously ill with COVID-19.
As of September 17, 2020, the Centers for Disease Control and Prevention (CDC) reported over 6.6 million cases of COVID-19 in the United States. The CDC anticipates another 150,000 to 340,000 by early October.
The Post-Intensive Care Syndrome and COVID-19: Crisis after a Crisis? study says, “At least 20% of the COVID-19 patients are reported to require supportive care in the critical care units. Patients infected with COVID-19 who are admitted to critical care often need 10 days of supportive care utilizing mechanical ventilation.”
Since workers’ compensation represents only between one and two percent of the overall medical spend, insurers, employers and third-party administrators will not see a huge number of COVID-19 claims with ICU treatment. However, the seriously ill workers they do see may suffer from post-intensive care syndrome or PICS.
The Home and Community-Based Physical Therapy Management of Adults with Post-Intensive Care Syndrome study defines PICS as “new or worsening impairments in physical, cognitive, or mental health status arising after critical illness that continue after acute care hospitalization.”
The syndrome is not limited to COVID-19 patients. Any person whose injury or illness has left them sedentary for more than five days can develop PICS symptoms, and these are much more prevalent if a worker has been ventilated.
PICS and Home Health Treatment
PICS can pose unexpected challenges for a claims representative. This is uncharted territory for adjusters who typically manage claims resulting from injuries not illnesses. Claims managers can expect the cost to care for a severe case of COVID-19 with PICS to be much higher than the average claim and need to take that into consideration when setting reserves.
PICs patients typically transfer from hospitals to post-acute care facilities. But these are not typical times. And some ill employees will be discharged directly home and need considerable home health care.
As with COVID-19 itself, PICS symptoms range from mild to severe. Some people have slight dizziness and weakness; others may experience extreme symptoms resulting in the inability to get out of bed by themselves. In the most intense cases, speech therapy may be needed after workers have been unable to talk for days while on a ventilator.
Depending on the worker’s condition, oxygen may be delivered to the home to help increase oxygenation in the blood as they come off ventilators. Other respiratory equipment may be prescribed, depending on the severity of the PICs symptoms.
Atrophy, balance issues, weakness, and difficulty walking are common, so physicians may order walkers, canes, and wheelchairs. They are likely to prescribe physical therapy to be delivered in the home, at a clinic, or via telerehab to restore strength, endurance, and balance. Occupational therapists are often deployed to help people regain the ability to perform activities of daily living.
Mental health symptoms of PICs and COVID-19 include nightmares, delirium, severe anxiety, deep depression, and even post-traumatic stress disorder. Ventilated patients can experience high levels of delirium and often feel betrayed by their doctors, nurses, and even family members. It’s important to call in a medical social worker, psychologist, psychiatrist, or other behavioral specialist to address these issues early.
As HomeCare Connect’s Managing Partner Teresa Williams indicated in her article last week, uncertainty exacerbates mental health concerns. Fear of the unknown is huge. Can they trust their doctor to have knowledge or experience to take care of them? Considering how little is known about the disease, its transmission and treatment, these fears are common.
Telehealth technology empowers the delivery of mental and behavioral health therapy as well as many medical services, including physician visits, physical therapy, and occupational therapy. Incorporating telehealth into the home health care program is particularly important when there’s a high number of COVID-19 cases in a geographic area.
When a worker is discharged to home after any illness or injury, having an appropriate home health agency is crucial to their recovery process. This is even more important if the worker has had a severe case of the coronavirus and has been hospitalized for several days or more. The agency needs staff who are experienced in caring for individuals recovering from COVID-19 and PICs.
Home health staff utilizing personal protective equipment (PPE), such as masks, gowns, face shields, and gloves at each visit is instrumental in the prevention and treatment of COVID-19. If the provider doesn’t have the proper PPE or is not wearing it correctly, call your home health management company or the agency immediately to report this concern.
PPE supplies were limited earlier this year when hospitals and other facilities received priority over home health providers. Fortunately, HomeCare Connect was able to proactively obtain and send needed PPE to their home health agency providers and to their injured workers.
It has been proven that performing proper hand washing using antibacterial soap is a key proponent of healthcare and recovery. Teaching the injured worker and family the importance and techniques of proper handwashing is critical.
During the pandemic, some workers and their families have taken on the added responsibility of checking the temperatures of anyone entering the home. This is especially important when someone is suffering from PICS or a catastrophic injury, such as a traumatic brain injury, paralysis, or a worker who has severe wounds as their immune systems are weakened.
Home health services should be highly customized to the needs of the injured or ill worker. The types of durable medical equipment, medical services, and mental health care depend on the severity of the PICS or COVID-19 symptoms. Clinically managing the illness and the costs of treatment can eliminate unnecessary costs while producing highly efficient outcomes. Now, more than ever, it’s important to have a home health partner you can trust.
About Anita Jovic
Anita Jovic is the Vice President of Clinical Operations for HomeCare Connect, overseeing its clinical team, programs and functions, including catastrophic care. She also conducts continuing education programs on a variety of home health clinical topics, including wound care, catastrophic care along with clinically driven home modification and durable medical equipment programs.
Anita has more than 25 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
Specializing in catastrophic cases, HomeCare Connect manages the quality and cost of home health care, post-acute care, DME and supplies, home modification and prosthetics and orthotics for workers’ compensation patients and payers. The Inc. 5000 and the Orlando Business Journal’s lists of fast-growing, privately held companies have captured its rapid growth. Based in Winter Park, Florida, near Orlando, the company serves clients nationally and can be reached at www.homecareconnect.com or 855-223-2228.
HomeCare Connect is a WorkCompWire ad partner.
This is not a paid placement.