The Case Manager
Last week, in Part One, I talked about the Discharge Planning Process. In Part Two, I wanted to continue the discussion and expand on how effective discharge planning can improve outcomes.
Areas covered in part one:
- Emphasize early communication with the facility team
- Highlight family involvement and education
- Address safety, mobility, home setup, equipment, and transportation
- Medication reconciliation and follow-up care
- Reinforce that discharge planning is ongoing, not a one-time event
Now, let’s focus on specific responsibilities for the Workers’ Compensation Case Manager
- Are there return-to-work barriers that need to be addressed before discharge?
- Ensure the claims adjustor has the supporting documentation to authorize home health, DME, transportation, and diagnostic testing to move the case forward.
- Work with the employer to prepare modified duty or transitional work based on the injured worker’s restrictions.
- Obtain the injured worker’s job description that the treating physician will need to determine readiness to return to work.
Communication and documentation are critical in workers’ compensation case management.
- What needs to be documented before discharge?
- Are there restrictions?
- Who needs to be notified (adjuster, employer, treating provider, therapy team) post-discharge so we ensure care is coordinated.
- Communicate changes in the plan or new needs to the injured worker and their family so they are prepared to go home.
Psychosocial and Emotional Readiness
- How is the patient coping emotionally with the transition home?
- Do they show signs of fear, anxiety, depression, or lack of confidence? This is especially important in catastrophic or long-term cases.
- How is the family coping?
Consider Social Determinants of Health.
In workers’ compensation, the injured worker may be the family’s breadwinner and just making it week to week on their salary; now, being on Comp, they get a lower salary if they cannot return to work. This can cause stress and anxiety and affect the injured worker and their family.
These issues may be outside the scope of the Workers’ Compensation Nurse Case Manager, but knowing resources to refer to is important.
What if the patient does not have health insurance? How will non-worker compensation conditions be covered?
Does the patient have food security?
Is there reliable electricity for equipment?
Are there financial barriers to transportation or caregiving?
These factors can derail a safe discharge.
Caregiver Burden
Is there a caregiver to assist the injured worker?
Is the caregiver physically and emotionally able to provide the required level of care? If not, coverage may be needed
Caregiver Burden is real and a major safety factor.
Red Flags After Discharge
What symptoms or changes should prompt a call to the provider or case manager?
When should the injured worker go to the ER?
Educating the injured worker and the family so they are prepared for treatments, equipment, and their diagnosis.
Keeping these areas in mind helps tie the clinical discharge plan back to the workers’ comp ecosystem. I hope this article is helpful. Please share Part One and Part Two with your teams. Add to them in accordance with your organization’s policy and procedures.
