A very interesting viewpoint was recently presented to us. What happens to employees permanently disabled by an injury at work? Obviously, they are not candidates for a return-to-work program. That is to say, they reside in nursing homes or receive lifetime medical care at home due to the nature of their workplace injury.
While an employer has an interest in controlling these medical costs, providing care management services supports the injured employee and offers the family peace of mind.
What “Care Managers” Do
It is very challenging to work with and protect the interests of chronically ill or disabled persons. A care manager works with clients to:
- Evaluate current and future needs.
- Act as an advocate within the healthcare and social services system.
- Coordinate care while protecting assets.
- Protect the clients’ best interests.
- Be available when family cannot.
- Speak with the client about subjects the family finds difficult to discuss.
- Listen to the person’s plans, wants and needs.
- Help them with unbiased recommendations so they may make informed decisions.
- Has the skills and knowledge to properly determine problems and come up with solutions.
- Has sizable resource they can call upon.
Quality Care Managers
Well-qualified care managers are registered nurses, master’s level social workers or vocational counselors with a background in the special needs of workers with semi- or permanent workplace disabilities from a workplace injury. They have a thorough knowledge of the workers compensation system, Medicare set-asides, and understand the intricacies of the social services and healthcare delivery system.
They have the skills to assess needs and interests, locate resources and oversee the best solutions from the most cost-effective resources.
Care Managers are usually employed by an established care management service company (like Broadspire, a third-party administrator). As such they are extensively trained and supervised.
The services of a care management service company are not attached to any home health agency, insurance carrier or facility, so care managers are free to offer a totally objective assessment of every issue. The only objective is the happiness and well-being of the clients and their families.
Care managers perform an assessment on the client’s functional, physical and cognitive status, as well as their environment and financial/legal situation. Following the evaluation, they provide a detailed analysis of the client’s status and recommend cost-effective solutions.
Complete Care Coordination
As advocates, medical advisors and surrogate family members, care managers take on many roles. They interview and screen in-home caregivers or hire contractors for home modification; attend doctor office visits, plan outings and visit clients to celebrate special occasions..
If placement in a nursing home or extended care facility is needed, the care manager locates appropriate options, checks all credentials and tours the facility with the client. They also determine suitable payment options and coordinate all paperwork.
Ongoing Care
Your care manager maintains the relationship for as long as you wish. They will:
- Be an advocate during hospital stays.
- Help arrange social activities.
- Coordinate benefits and audit medical bills.
- Help with moves or transitions.
- Supervise aspects of in-home and facility services.
Legal and Financial Assistance
It can be quite a challenge to successfully manage disbursements from trust funds, protect the beneficiary’s eligibility for government-provided care. Fiduciary and legal representatives serve as healthcare representatives, evaluating the client’s health, needs and benefits, coordinate healthcare, and protect everyone involved against legal liability arising from misuse of funds.
Fiduciary and Legal Representatives provide:
- Coordinated resources, equipment, medical and social services.
- Transition coaching to a more independent, productive life.
- An evaluation of appropriateness for trust funds disbursements.
- Assessments of medical needs with healthcare professionals.
- An appropriate environment to reduce risk.
- Identification of community services to supplement existing care.
- Alternatives for care.
- Assistance with Independent Education Plan (IEP) meetings.
Navigating the Healthcare and Social Services Systems
Working within a bureaucracy to help special needs individuals is complex and often overwhelming. Some states even require attendance at court appearances. Understanding the required documentation is often intimidating.
Care managers have the expertise to organize the information needed, complete the required forms and even attend hearings for the client, thus avoiding missteps that could take months or even years to clear up. A care management service relieves the burden of staying compliant with the system’s guidelines.
Contributor: Broadspire provides workers compensation claims adjusting services and third-party administrative services. This service is available unbundled and bundled for Broadspire clients and companies that are not currently clients. For information contact 1-866-625-1662 or [email protected] or www.ChooseBroadspire.com
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
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