Personal visits give insight into return-to-work cases
September 1, 2002 4 minutes read
CMs should see the home, workplace firsthand
When you’re managing return-to-work cases, there’s no substitute for personal visits to the home and job site, asserts Diane Schneider, CDMS, CCM, CRC.
"During a home visit or site visit, the case managers can observe many situations that could impact recovery. You see firsthand the social factors, family issues, and working conditions that are unique for each ill or injured person," says Schneider, who is director of disability management case management products for Intracorp, a Philadelphia-based health care management company.
The company provides case management services for a variety of clients including insurers, employers, third-party administrators, unions, state and local governments, and managed care organizations. Intracorp provides both telephonic and on-site case management services to people who are ill or injured.
"On those cases that need a deeper level of intervention, Intracorp’s standard protocol is to have an experienced case manager meet face-to-face with the injured or ill person, employer, and providers," Schneider says.
The interview, which typically takes an hour to an hour and a half, gives the case manager a total picture of the person, his or her family, and the environment in which they live.
"These face-to-face visits add incredible knowledge and insight that help the case manager coordinate medical services and return-to-work job opportunities as quickly as possible," she adds.
The case managers determine the ill or injured person’s understanding of their diagnosis and treatment, talk to them about their employer, obtain feedback about their perceived ability to work in any capacity, and help them work with the insurance company, their employer, and their providers.
"All the time, we are interviewing the ill or injured person, we are observing their interactions with family members and friends and documenting the home environment," Schneider says.
Home visits help the case managers determine all of the factors that may affect recovery and return to work.
For instance, there may be family members who cater to ill or injured relatives and won’t allow them to do the activities of daily living that can help recovery, or the injured client may be doing home activities that actually exacerbate his or her symptoms and lengthen the recovery time.
"When I did home visits, I encountered a lot of people with back and knee injuries who were now involved in their family’s childcare and demonstrated improper body mechanics or participated in hobbies that required physical capabilities that were beyond safe levels given their current diagnosis and stage of recovery," she says.
Case managers are able to spot leisure activities or hobbies that the injured worker should avoid during recovery, or may discover a hobby the client has given up that can be beneficial to recovery.
Site visits
A case manager may detect indications of financial difficulties, drug abuse, or other factors and arrange for help from community agencies as well as alert their providers of factors at home that may be affecting their current treatment plan and recovery.
"These site visits give case managers information we can share with the provider that assists them in understanding the full picture and help them build a treatment plan that meets the individual’s needs," Schneider says.
For instance, a case manager may notice that a patient is having problems with daily living skills or is not doing them appropriately and can suggest to the provider that home visits from a physical therapist may be beneficial.
Onsite visits to the work environment also are incredibly beneficial, she says.
"It is rare when an employee’s description of their job matches an employer’s description. Yet as a case manager, it is your role to determine if the job matches the physical capabilities outlined by the provider to assure a safe return-to-work environment," Schneider says.
Visiting the job site takes the guesswork out of determining the job requirement and helps ensure a safe and sustained return to work, she says.
It gives the case manager the opportunity to complete a detailed analysis of the job and define the physical requirements needed to perform that job, allowing the case manager to provide the physician with detailed information needed to assess when the employee can return to work safely.
"While visiting the job site, we also educate the employer by identifying simple modifications and other temporary tasks that can be performed with less physical requirements to assist with a transitional return-to-work during recovery," she adds.
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