meeting 2890414 640

Case Management Focus: The Life-Long Impact of a Catastrophic Injury on the Worker

17 May, 2023 Anne Llewellyn

meeting 2890414 640

Sarasota, FL ( -- As a case manager, I have worked with several people who sustained catastrophic injuries. My role was to help them work through the system, settle them with needed resources, and close the case. In a worker's comp case, I would work the case till the patient reaches maximum medical improvement (MMI). Once reached, the treating physician would give an impairment rating to decide on a settlement. Once this happened, I would close the case and wish the patient and family luck. I thought of them over time and wondered how they lived their new normal.

A Real Life Event

Recently, I have been working with a man who sustained a spinal cord injury in 2020 while he lived in North Dakota. He made a remarkable recovery; for example, he could come off the ventilator in record time, had his feeding tube removed, and could eat regular food without complications. He was able to talk and share his wishes and look forward.

Unfortunately, due to COVID, he did not have access to a coordinated rehabilitation program. The hospital plan after 7 months was to send him to a nursing home as he was medically stable and did not require hospitalization. The patient refused this transfer as he knew he would die if he went to the nursing home. He talked to his family, who lived in Florida, and they agreed to take him in and care for him. He gave the case manager his debit card so she could arrange a transfer home. He was put on a plane and flew home alone from North Dakota to Jacksonville, Fla., where his family met him.

It was at this time I became involved in his life.

Once home, he lived with his mother in Lake City, Fla. He was sent home with a few prescriptions and a recommendation to follow up with his primary care doctor. His sister left her job and traveled 2 hours round trip to bathe him, feed him and do wound care for the Stage Four decubitus ulcers he acquired in the hospital. After a few weeks, his sister asked him if he wanted to move to her home as it would be easier for her. He agreed and he was moved to Fort White, Fla.

In talking to my patient about his benefits, I learned he was on Social Security Disability and was enrolled in Florida Medicaid. I knew that he could get on a program called Long Term Florida Medicaid that would pay a small amount to his sister for taking care of him and providing equipment and other supplies he would need. I started the application. It did take some time, but with perseverance, he was approved.

Overall, he did well, but he did have some issues that caused visits to the Emergency Department for constipation, frequent urinary tract infections, and decubitus ulcers. He did have a case manager through the Medicaid long-term managed care company, but no home care services were available due to the rural area where he lived. To be a better caregiver, his sister turned to YouTube to learn how to care for him. She learned how to do a bowel program which has allowed the patient to be continent. She learned how to care for the suprapubic tube so that the urinary tract became less frequent. She also learned how to do wound care to heal decubitus ulcers. I was able to get him an appointment with a large rehabilitation center in North Florida. Due to the ulcers, he could not be admitted. With his sister's new routine, within a few months, the wounds were healed, and he was admitted to the rehabilitation center for 2 weeks. The rehab program gave him a taste of what progress a rehab could be make. Unfortunately, the insurance company only approved for the inpatient program for two weeks. This time frame did not allow him to take advantage of the full impact of therapy. Once discharged he was supposed to go to rehab, but transportation could not take him and there were no Medicaid home care providers in the area. He was told to hang in there till he went on Medicare, that things would improve.

Workers' Comp 101: What is maximum medical improvement, or MMI? It is a condition that has become permanent, i.e., one that will, with reasonable probability, continue for an indefinite period of time without any present indication of recovery therefrom. See State ex rel. American Standard, Inc. v. Boehler, 788 N.E.2d 1053 (Ohio 2003).

We applied for many things so that his caregiver could care for him, but they were denied as 'Medicaid' did not pay for them. I was able to tap into community resources and get things donated or funded. It was hard as everything seemed to be a fight. Life went on, and when he was eligible for Medicare, more services were provided as there were more providers to put services into place.

The patient, anxious to move on with his life, called the State’s Vocational Rehab office to request help. A Vocational Counselor came out to see him, did testing, and felt he was employable. The patient was told by several people he would lose his benefits if he went back to work. He was cautious and worried about this, so he did not pursue the opportunities presented by Vocational Rehab. Transportation has been an issue also. There is Medicaid Transportation, but it can only take him to medical appointments, nothing social or work related. As a result, he is confined to his room in the trailer where he lives a very secluded life. The family did not have the funds to get a modified vehicle.

What I learned:

So, two, almost three years later, my patient is living his ‘new normal’. It is not easy, but he has a great attitude and takes life in stride, but it is hard for him as he is an outgoing person who knows there is more, he can do.

At the suggestion of a friend, he started a GoFundMe to raise funds to purchase a modified vehicle that would allow him to have a more normal life. He has raised some money but has a long way to go! If you are so inclined, feel free to donate! Troy would be appreciated.

As his nurse advocate, I provide encouragement and work to continue to find resources to help him move forward. He is making plans, and I support his ideas.

I also recognize that the healthcare system does empower people; it keeps them down. It is sad to see firsthand. It is up to the patient, the family and other supporters to help each person meet the needs they have.

I now realize there is no set timeline for the work as a nurse case manager or a nurse advocate; it does not end after a worker’s comp settlement is reached or the patient is at home with this family. Patients with catastrophic injuries have lifelong issues that require resources of all kinds to meet their ongoing needs.

I know I am not done advocating for Troy. His motivation drives me to help him get to the next level. Any ideas you have would be appreciated. Please email me at
Thanks for reading! Have a good week!

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    About The Author

    • Anne Llewellyn

      Anne Llewellyn is a registered nurse with over forty years of experience in critical care, risk management, case management, patient advocacy, healthcare publications and training and development. Anne has been a leader in the area of Patient Advocacy since 2010. She was a Founding member of the Patient Advocate Certification Board and is currently serving on the National Association of Health Care Advocacy. Anne writes a weekly Blog, Nurse Advocate to share stories and events that will educate and empower people be better prepared when they enter the healthcare system.

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