Medical Case Management For Closed Head Injury Cases

There are many reasons medical case management may be a good solution to support the care and coverage of people who sustained a head injury. Depending on the severity, head injuries may only require a few months of care, but many injuries may require continued care over the course of years or the rest of a person’s life. 

Traumatic Brain Injuries (TBI)  are at the forefront of deaths and disabilities every year. A TBI may cause long-term problems related to cognitive difficulties, paralysis, decreased mobility, memory loss, loss of hearing or vision, and even personality changes. These deeply impact the quality of life available to the person who suffered the injury.

Closed Head Injury Workers Compensation

If you, or a loved one, has a workers’ compensation case due to a work-related injury, you may need the assistance of a certified nurse life care planner or a legal expert life care planner. These types of injuries can cause overwhelming feelings surrounding the number of healthcare options and the next steps and some clarity can be gained by talking to a professional. After an injury at work occurs, usually a referral is made to a nurse consultant who can assist with the handling of complex medical issues. A certified nurse consultant can point caregivers in the direction of resources, provide guidance, and work directly with other professionals involved in a case such as:

  • Insurers
  • Attorneys
  • Employers
  • Brokers

Benefits of Early Referral

Early referrals help the nursing case manager’s timeline to receive and process files and documents including medical records, claim documents, background info, and health insurance benefits details, while prioritizing the injured party’s immediate needs in addition to assisting with:

  • Establishing relationships with the patient’s family
  • Communicating with the treatment team at the acute care hospital
  • Proactively planning for a patient’s discharge
  • Ensuring continuity of care between different medical professionals and facilities
  • Containing costs of treatment

Establishing A Relationship with Family

A medical case manager can guide families through disagreements about the best course of action regarding healthcare options. A strong relationship can also provide the opportunity for families to agree on the best use of financial resources. While helping families with difficult conversations, they can also assist with other areas of communication such as:

  • Help the family adjust to a disability and how it affects all family members
  • Develop a sense of rapport and open communication to gain trust within the family
  • Provide specialized skill and knowledge to educate the family on how lifestyle may change post-injury
  • Be available as a resource for issues as they may arise for the patient and their family

Communication with Treatment Team

Creating a treatment plan for the injured person requires professional experience as well as incorporating information from a variety of sources to ensure that it is comprehensive and accurate, while also factoring in the specifics of the injury. While treatment plans are commonly used with traumatic brain injuries or TBIs, there are other injuries that may need consideration as well. An experienced case manager can assist with a variety of injuries and help:

  • Determine the extent of the injury and how to coordinate care
  • Confer with the medical team regarding recommended treatment and plan of care
  • Facilitate and coordinate discharge planning for care after the hospital

Planning and Identifying Barriers Affecting Discharge

Medical case managers can also identify and coordinate potential issues that may arise after an individual is discharged from a hospital or care facility to streamline long-term care or rehabilitation after in-patient care. 

After discharge, a case manager can also assist in the coordination of care between multiple medical professionals and facilities as well as ensuring treatment costs are contained. If an individual finds themselves in a more complex living situation, a medical case manager can assist with the following:

  • Patient is under a guardianship or conservatorship
  • Care is needed from an acute rehabilitation facility or skilled nursing facility
  • The injured are homeless or in an unsafe living situation
  • Lacking family, friend, or peer social support
  • Pre-existing medical history that makes treatment more complicated

Discharge Planning

By not only looking at the kind of injury, but also considering the severity of the injury, the goal of the case manager is to help the person recover as much of their independence as possible while keeping in mind the physical and mental health of the person. The severity of the injury will indicate to what extent the person can recover and how quickly that recovery can take place. Case managers can handle negotiations on treatments and rehabilitation while also processing work releases and full duty releases. Case managers can identify the least restrictive environment for care from the following:

  • Acute rehabilitation facility
  • Skilled Nursing Facilities
  • Community-based residential program
  • Discharging Home

Acute Rehabilitation Setting

Depending on the care required for best outcomes, there may be a variety of clinicians needed to assist in the long term care and planning for individuals who are the victims of a traumatic brain injury. If an acute rehabilitation is determined best for an individual’s situation, a medical case manager can assist by:

  • Attending weekly team meetings as part of the treatment team
  • Determine appropriate length of stay in a rehabilitation facility
  • Collaborate with the team regarding the next level of care
  • Frequently communicate with all involved parties (i.e. guardian, family, insurer, attorney, employer) to streamline the process

Skilled Nursing Facilities

If the injuries sustained will require more in-depth care to assist with the injury, a skilled nursing facility may be the best choice to ensure safety and well-being for the individual. This would include in-patient care with the assistance of a staffed team of medical professionals as well as a case manager who:

  • Attend weekly team meetings as part of the treatment team.
  • Determine appropriate length of stay in the facility.
  • Collaborate and communicate with the care team regarding the next level of care needed.
  • Relay relevant information to all involved parties (i.e. guardian, family, insurer, attorney, employer)

Community-Based Programs

Some states provide local level assistance by means of independent living programs as well as hospital or rehabilitation programs for individuals with circumstances that don’t allow them to have care or assistance at home. Community based programs are sometimes indicated when a home situation can’t accommodate the needs of the patient or fall into one of the following situations: 

  • 24 hour supervision is required for the safety of the patient
  • Behavioral issues that require medical guidance or supervision
  • Patient is homeless or doesn’t have a safe living environment

Discharging Home

It’s crucial when released home that the proper care plans have been set up and established by a care team specifically and tailored to the individual’s specific needs and injuries. Case managers are able to review a patient’s specific injury and post-care needs help with:

  • Ensuring their home environment is set up properly and safely
  • Coordinating any durable medical equipment that may be needed
  • Coordinate all home care and therapy services
  • Providing support to family and/or caregiver
  • Performing continual assessments regarding the injured ability to remain at home

Follow-Up Care

Follow up care is critical to a patient’s recovery to help alleviate stress as well as streamlining aspects of care and to prevent issues like prescription delays or missed appointments. These can be crucial to rehabilitation when an injured individual is out of the hospital dependent on the severity of the injury. There are three levels of severity in traumatic brain injuries:

  • Post Concussive/Mild Brain Injury
  • Moderate Brain Injury
  • Severe Brain Injury

Post Concussive/Mild Brain Injury

A mild brain injury can sometimes be referred to as a concussion and can occur from some trauma to someone’s head either with or without consciousness and can lead to only temporary cognitive impairment. The treatment is as follows:

  • Assessment and treatment provided by a brain injury specialist (NOT a primary care physician)
  • Vestibular therapy or vestibular rehabilitation therapy is a form of physical therapy that usually involves head movements
  • Physical/occupational therapy
  • Medication management if needed

Moderate Brain Injury

A moderate brain injury can have similar symptoms to a traumatic brain injury and can occur when brain function gets disrupted for longer than a few minutes. More severe that a mild injury and requires special treatment by a medical professional such as:

  • Treatment provided by a physician who specializes in the brain (neurologist)
  • Cognitive therapy to help with behavior post injury
  • Managing and medications needed to treat the injury
  • Neuropsychological evaluation to assess brain function post accident

Severe Brain Injury

These can occur when there is extensive brain damage that happens from something such as a car accident or severe injury. These injuries usually demand the most medical intervention and treatment that can be lifelong at times and require:

  • Treatment provided by neurology, neurosurgery or multiple speciality providers depending on the severity of the injury
  • Multiple medications for treatment
  • Physical and/or occupational therapy, sometimes long-term
  • Speech language therapy depending on the injury and part of the brain affected

Conclusion

A medical case manager can be helpful whether an individual experiences a traumatic brain injury or any type of serious injury that affects their ability to do day-to-day activities. Occupational Resource Network’s medical case management experts are able to provide a range of services and create life care plans to help individuals who have sustained traumatic injury based on years of clinical experience. Their vast knowledge allows them to give a comprehensive report that includes an outline of psychological, rehabilitation, and medical needs that may be needed in the future. With years of experience in a variety of cases, contact a professional today to discuss your needs.

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