Nurse Case Manager Chronicles

A Place to Heal

One case manager found a way to ground her free-spirited patient without dampening his independent streak.
By: | October 9, 2017 • 5 min read

This is the first in a series highlighting the passion and ingenuity of workers’ comp nurse case managers and an examination of how injured workers and payers can benefit from their properly-applied expertise.

Advertisement




Rare is the case when an injured worker is homeless — but it happens. And it adds layers of complexity that take ingenuity and intuitiveness on the part of a nurse case manager.

Catherine Hill faced this challenge with one patient, an evening-shift roadside worker. The man was laying out cones on a highway when he decided to jump from one trailer to the next. Unfortunately, he missed.

The worker broke his hip but didn’t go to the emergency room until two days later, when the pain became unbearable. A physician admitted the worker, prepped him for surgery and operated the same day.

While he recovered in the rehab unit, Hill, a nurse case manager with Ascential Care, learned that the worker had been living in his van.

That arrangement might have been fine while he was physically fit, but it wasn’t going to fly for a man recovering from hip surgery, said Hill, a registered nurse certified in occupational health and case management.

“He adapted to living in the heat and the cold, but we identified that he could not live like that after injury. The van was not an option,” she said.

Appropriate Housing

The injured worker needed a home until he was on his feet again, so the nurse case manager began the task of finding a suitable living space for him.

His particular injury didn’t qualify him for room and board at a skilled nursing facility. But the homeless shelter Hill contacted wouldn’t take him either. The shelter, she learned, wouldn’t accommodate him because of his van.

Catherine Hill, nurse case manager, Ascential Care

“Shelters oftentimes are of the belief that if the person seeking shelter owns any sort of property, then they have the ability to pay for shelter,” explained Hill.

Hill explored further options. Eventually she found a hotel to temporarily house the worker in during recovery. She confirmed there was a refrigerator and microwave in the hotel room so that he could prepare meals. She conducted a site visit, made sure he was in a handicap-accessible room, and organized a medication drop-off and pick-up schedule.

She also coordinated the financial details. She spoke with the claims adjuster and determined the hotel rate was more economical than it would have been to send the worker to a rehab facility.

“Costs would have been huge if Catherine hadn’t found that hotel. The cost savings just based on hotel fee versus inpatient [facilities] are quite dramatic when factored into case savings,” said Hill’s supervisor, Courtney Bryant.

“A skilled nursing or inpatient rehab facility costs on average $283 per day. Depending of the inpatient rehabilitation facility, costs can range up to $1,300 per day. Costs for this case were under $100 per day.”

Finding the Balance

Hill quickly realized that location wasn’t the only potential obstacle to healing for this worker. He was a smart, resourceful man, used to being on his own. Accepting help didn’t come naturally to him.

“He wanted to be independent,” said Hill. “Initially, I believe that it was difficult for the injured worker to adjust to depending on others to help with his overall care.

Advertisement




“The main challenge for me was to ensure that the injured worker understood he should not drive his van due to being on narcotic medication and decreased mobility. I do believe he would have gone back to his van immediately following discharge although the doctors advised against doing so.”

Hill checked in with regular phone calls to keep tabs on his progress but also just to listen.

“He would always start his conversation by saying, ‘I’ve been thinking about…’ then launch into his thought-provoking conversation. When he was done talking, he’d stop, take a breath, laugh at himself and say, ‘I guess I just needed to talk to someone,’” said Hill. “I really feel that this injured worker saw me as a friend.”

By earning his trust and understanding what he needed to thrive, Hill was able to preserve the delicate balance between allowing him to remain independent and ensuring that he didn’t put his recovery at risk.  The injury may have slowed him down, but it didn’t stop him from doing anything for himself.

“The patient never said that he could not do something; he always found ways to adapt to the environment in order to meet his daily living needs,” Hill said.

“He wanted to be independent … I believe that it was difficult for the injured worker to adjust to depending on others to help with his overall care,” – Catherine Hill, nurse case manager, Ascential Care

On the plus side, his independent streak made him highly motivated to comply with his treatment. During physical therapy, Hill said, he always gave 110 percent. He would unabashedly ask for what he needed to recover, his goal to remain in full control of his decision making.

After two months, the worker had healed.

“I think that being in the hotel for two months actually ended up being a good thing for him,” Hill continued. “It provided protection from the hot weather and ensured less risk of reinjury. The hotel was sort of a respite period from his daily challenges of being homeless.”

After recovery, she said, the patient relocated to be near old friends, which resulted in him finding new work. A self-defined ‘free spirit,’ said Hill, “this patient did not want to commit to being in one area for a long period of time.”

The Whole Person

“When going into this field, hearing the term nurse case manager, you’re strictly thinking of the medical parts,” Hill said. “You don’t readily think about psychosocial issues. Every person carries their own.”

Psychosocial issues point to a number of things, like a patient’s living situation or a patient’s habits. Comorbidities, lack of temporary work assignments, depression, poor coping skills, lack of living essentials all contribute to the outcome of a workers’ comp case.

Advertisement




“This patient made me remember why I became a nurse,” said Hill. “He reminded me that all things can change in the blink of an eye and that no matter your education, economic and/or social status, everyone is human and can be in need of a hand during a down period.”

She noted that during the initial visit at the hospital, the injured worker was impressed a nurse would take time out of the weekend to check in on him.

“I believe I offered an emotional and mental stability. You have to meet the patient where they are,” said Hill. “I may go in to help the employee get back to work without restrictions, but I’m also going in to get them back to normal life.”

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Management

The Profession

As risk manager for a cloud computing and software company, Laurie LeLack knows that the interconnected economy and cyber security remain top risks.
By: | December 14, 2017 • 4 min read

R&I: What was your first job?

One of my first jobs was actually at a local insurance agency when I was a high school student, before I had any idea I was going to get into insurance. After college, I was a claims analyst at Sunbeam.

R&I: How did you come to work in risk management?

I fell into it after college, where I studied international business. I had a stack of resumes, and Sunbeam came to Florida from Rhode Island, so I applied. I interviewed with the director of risk management and just stuck with it and worked my way up.

R&I: What is the risk management community doing right?

Advertisement




Getting a holistic view of risk. Risk managers are understanding how to get all stakeholders together, so we understand how each risk is aligned. In my view, that’s the only way to properly protect and serve our organizations.

R&I: What could the risk management community do better?

We’ve come a long way, but we still have to continue breaking down silos at organizations. You also have to make sure you really understand your business model and your story so you can communicate that effectively to your broker or carrier. Without full understanding of your business, you can’t assess your exposures.

R&I: What was the best location and year for the RIMS conference and why?

Being on the East Coast, I like Philadelphia.

Laurie LeLack, Senior Director, Corporate Risk and Americas Real Estate, Citrix Systems Inc.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

Organizations understanding their cyber risk exposures and how this line of insurance can best protect them. Five to ten years ago, people shrugged it off as something just for technologies companies. But you can really see the trend ticking up as a must-have. It was always something that was needed, but people came to their own defining moments as we got more involved in electronic content and social media globally. Cyber risk is inherent in the way we do business today.

R&I: What emerging commercial risk most concerns you?

The advent of security and contractual obligations. These are concerns as we all play a part in this big web of a global economy. There’s that downstream effect — who’s going to be best insulated at the end of the day should something transpire, and did we set the right expectations?

R&I: Is the contingent commission controversy overblown?

Advertisement




I think so. At the end of the day, it’s all about the transparency you’re getting from the people you work with. I think some best practices in transparency came out of the situation, but we were working on a fee basis, so it wasn’t as much of an issue for us as it may have been for other companies.

R&I: Are you optimistic about the U.S. economy or pessimistic and why?

I’m cautiously optimistic. We seem to be stable in terms of growth, and I’m hoping that the efficiencies and the economies of scale we achieve through technology will benefit us. But I’m also worried about the impact that could have on the number of jobs globally.

R&I: Who is your mentor and why?

Robert O’Connor, my former director when I was first on-boarded at Sunbeam, gave me so many valuable tidbits. I’ll call him to this day if I have an idea I want to bounce off him. He’s a good source of comfort and guidance.

R&I: Of what accomplishment are you most proud?

I have two very empathetic, healthy and happy boys. Eleven and soon-to-be 14.

On the professional side, there were a lot of moments during my career at Citrix where we were running a very lean organization, so I had the opportunity to get involved in many different projects that I probably wouldn’t have had in other larger organizations.

R&I: What is your favorite book or movie?

My favorite movie is Raiders of the Lost Ark.

R&I: What’s the best restaurant you’ve ever eaten at?

A place in Santa Barbara called Bouchon.

R&I: What is the most unusual/interesting place you have ever visited?

Advertisement




Caverns in Gatlinburg, Tennessee. They were interesting. It was cool to see these stalagmites and stalactites that have been growing for millions of years, and then just above ground there are homes from the 1950s.

R&I: What is the riskiest activity in which you’ve ever engaged?

Riding on the back of my husband’s Harley.

R&I: What about this work do you find the most fulfilling or rewarding?

I like educating people and helping them find their ‘aha’ moment when you highlight areas of risk they may not have thought about. It allows people to broaden their horizons a little bit when we talk about risk and try to explore it from a different angle. I try not to be the person who always says “No” because it’s too risky, but find solutions that everyone is comfortable with given a risk profile.

R&I: What do your friends and family think you do?

I tell my kids I protect people and property and sometimes the things you can’t feel or touch.




Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]