Nurse Case Manager Chronicles

Homeless and Injured: Finding One Workers’ Comp Patient 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 • 6 min read

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

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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.

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“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.”

Treating 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.

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“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 the digital producer and a staff writer at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

2018 Risk All Stars

Stop Mitigating Risk. Start Conquering It Like These 2018 Risk All Stars

The concept of risk mastery and ownership, as displayed by the 2018 Risk All Stars, includes not simply seeking to control outcomes but taking full responsibility for them.
By: | September 14, 2018 • 3 min read

People talk a lot about how risk managers can get a seat at the table. The discussion implies that the risk manager is an outsider, striving to get the ear or the attention of an insider, the CEO or CFO.

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But there are risk managers who go about things in a different way. And the 2018 Risk All Stars are prime examples of that.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Goodyear’s Craig Melnick had only been with the global tire maker a few months when Hurricane Harvey dumped a record amount of rainfall on Houston.

Brilliant communication between Melnick and his new teammates gave him timely and valuable updates on the condition of manufacturing locations. Melnick remained in Akron, mastering the situation by moving inventory out of the storm’s path and making sure remediation crews were lined up ahead of time to give Goodyear its best leg up once the storm passed and the flood waters receded.

Goodyear’s resiliency in the face of the storm gave it credibility when it went to the insurance markets later that year for renewals. And here is where we hear a key phrase, produced by Kevin Garvey, one of Goodyear’s brokers at Aon.

“The markets always appreciate a risk manager who demonstrates ownership,” Garvey said, in what may be something of an understatement.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Dianne Howard, a 2018 Risk All Star and the director of benefits and risk management for the Palm Beach County School District, achieved ownership of $50 million in property storm exposures for the district.

With FEMA saying it wouldn’t pay again for district storm losses it had already paid for, Howard went to the London markets and was successful in getting coverage. She also hammered out a deal in London that would partially reimburse the district if it suffered a mass shooting and needed to demolish a building, like what happened at Sandy Hook in Connecticut.

2018 Risk All Star Jim Cunningham was well-versed enough to know what traditional risk management theories would say when hospitality workers were suffering too many kitchen cuts. “Put a cut-prevention plan in place,” is the traditional wisdom.

But Cunningham, the vice president of risk management for the gaming company Pinnacle Entertainment, wasn’t satisfied with what looked to him like a Band-Aid approach.

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Instead, he used predictive analytics, depending on his own team to assemble company-specific data, to determine which safety measures should be used company wide. The result? Claims frequency at the company dropped 60 percent in the first year of his program.

Alumine Bellone, a 2018 Risk All Star and the vice president of risk management for Ardent Health Services, faced an overwhelming task: Create a uniform risk management program when her hospital group grew from 14 hospitals in three states to 31 hospitals in seven.

Bellone owned the situation by visiting each facility right before the acquisition and again right after, to make sure each caregiving population was ready to integrate into a standardized risk management system.

After consolidating insurance policies, Bellone achieved $893,000 in synergies.

In each of these cases, and in more on the following pages, we see examples of risk managers who weren’t just knocking on the door; they were owning the room. &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, clarity of vision and passion.

See the complete list of 2018 Risk All Stars.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]