Those of us who have years of experience working withcatastrophically injured claimants see the disturbing pattern timeand time again: The claimant presents to the emergency room withthe initial injury and subsequently travels through a fragmentedhealthcare delivery system that all too often stops woefully shortof meeting the claimant’s long-term needs. While naturally there issignificant focus on early intervention strategies and medicallymanaging the workers’ compensation aspects of a new CAT claimduring the early life-saving and acute phase of the injury, thereis dangerously little attention and effort devoted to thecoordination of long-term management of these high-risk for failureclaimants.

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Catastrophically injured claimants are often discharged too soonand/or to the wrong setting, unarmed with the knowledge and insightrequired to navigate their permanently changed lifelongjourney.

Traumatic brain injured claimants, for example, may bedischarged home from a hospital or acute inpatient rehabilitationfacility only to find themselves and their caregivers unable tocope with the sequelae of the work injury. This puts tremendousstrain on the claimant and family, which often has a devastatingimpact on the recovery process. Although initially, the effects ofa brain injury may not be physically apparent, they continuouslychallenge the claimant on a daily basis. Attention deficits, moodswings, depression, anxiety, anger, PTSD and behavioral challengesare common. If the big picture of brain injury rehabilitation isnot addressed from the inception of the claim, these claimants maytravel down new catastrophic paths including substance abuse,behavioral crises, misdiagnoses, incarceration, hospitalreadmissions and eventually, costly lifetime medical and indemnitybenefits especially if the claimant experienced the injury at ayoung age. In other words, claimants get stuck unnecessarily in adetrimental and expensive “vortex of failure.”

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How can this “vortex of failure” be stopped?

Challenging the traditional post-acute care delivery model isthe key. Catastrophically injured claimants require specializedcare and rehabilitation services, which is where the traditionalcare model often stops, fails or misses the boat. At the outset ofa CAT claim, we must begin to think differently about the “stepdown” process for a catastrophically injured claimant. If we expectthese individuals to successfully integrate into their family andcommunity once medically stable, we need to consider moving themfrom a highly-institutionalized setting (hospital, acute inpatientrehabilitation facility, skilled nursing facility) to a therapeuticresidential rehabilitation setting before sending them home. Thisis a critical point on the post-acute care continuum that can bethe vortex breaker.

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Identifying the next step

Insurance payers, case managers, physicians, discharge planners,etc. need to ask these questions before recommending the next“step-down”:

- What additional services will the claimant need in order tofunction independently?
- How will the injured claimant adapt to normal living, home lifeand the community?
- Can he/she return to work? - Does the claimant have close familyor a caregiver? Will the family be able to cope with the effects ofa traumatic brain injury or do they need time, training andsupport?

These critical questions must be answered and plans should bemade to deliver the necessary services and real-life experiencesthat today are not accounted for in most post-acute carerehabilitation settings.

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What should you look for?

- Interdisciplinary and specialized community- integratedresidential rehabilitative treatment that will maximize recoveryand address long-term needs.
- Family education and participation in the claimant’srehabilitation program in order to develop the knowledge, skillsand advocacy abilities necessary to support the injured individualthrough a lifetime.

There is a strong correlation between the timing and duration ofaggressive rehabilitation and an injured worker’s chances of everreturning to work and a life with purpose. Physical, social andvocational goal-setting by an expert team of rehabilitationclinicians can effectively move the claimant from where they are towhere they want to be. We can safely assume that catastrophicallyinjured workers do not want to be stuck in a “vortex of failure.”Let’s break that paradigm and work harder to re-integrate theseinjured individuals back into our communities.

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Lydia Hendrix RN, BSN, MSSL, CRRN is the chief operatingofficer/division chief executive officer of NeuLifeRehabilitation in Mount Dora, Florida. Hendrix has a B.S. innursing from Florida State University, and a M.S. in strategicleadership from Mountain State University. She has worked as asurveyor for the National Commission on Accreditation ofRehabilitation Facilities (CARF) and the Florida Department ofHealth-Brain and Spinal Cord Injury Program. She is also the 2016-2017 President of the Central Florida Association of RehabilitationNurses (CFARN). Hendrix can be contacted via LinkedIn.