Discussion: View Thread

Hello everyone,

I would like to know what is the criteria used by life care planners when considering inclusion of  case management services for brain injury clients in the LCP.  I realize that that the inclusion of the nurse case management services may be based on client's case and specific circumstances. I would appreciate  to hear any and all ideas.

Kind regards,

Nellie

------------------------------
Nellie Kreimer
nkreimer@msn.com
North Woodmere, NY United States
------------------------------

I'm glad you brought this up.  I, too, am curious about how other life care planners are handling this.  I include case management in many of my life care plans, I have defended it in court, and the juries have gone along with it.  With the challenges of the health care delivery system, and the complexities of future medical care for many of these cases over decades, it seems to be helpful, especially since I can recall, from my years working for Crawford and Company, that case management was really needed for these people and their families.  Also, can we assume that the spouse will always be there as a caregiver? 

------------------------------
Ellen Fernandez
efern338@aol.com
Indialantic, FL United States
------------------------------

Original Message:
Sent: 06-03-2015 22:27
From: Nellie Kreimer
Subject: case management and brain injury

Hello everyone,

I would like to know what is the criteria used by life care planners when considering inclusion of  case management services for brain injury clients in the LCP.  I realize that that the inclusion of the nurse case management services may be based on client's case and specific circumstances. I would appreciate  to hear any and all ideas.

Kind regards,

Nellie

------------------------------
Nellie Kreimer
nkreimer@msn.com
North Woodmere, NY United States
------------------------------

Original Message------

Hello everyone,

I would like to know what is the criteria used by life care planners when considering inclusion of  case management services for brain injury clients in the LCP.  I realize that that the inclusion of the nurse case management services may be based on client's case and specific circumstances. I would appreciate  to hear any and all ideas.

Kind regards,

Nellie

------------------------------
Nellie Kreimer
nkreimer@msn.com
North Woodmere, NY United States
------------------------------

I agree with Regina about the 4-8 hours per month-some months might be more some less, but I think that is a good overall long term estimate.   My main function is as a CCM and once the client reaches a stable situation there are still things that need to be done long term.  

------------------------------
Karen Roberts, RN, BSN, CCM
Nurse Case Manager
kroberts@indequest.com
Plymouth, MI United States
------------------------------

Original Message:
Sent: 06-04-2015 09:53
From: Regina Pepin
Subject: case management and brain injury

Hi Nellie,

I would say between 4 and 8 hours per month, depending on the client and  level of need. I do some private case management and have one client in a group home for medically complex, and another out in the community in a fairly independent group home.  For my complex client in a nurse-run facility, I average about 3 - 4 hours per month since the facility does the vast majority of the case management. My involvement is to act as a liaison between family and facility, make sure the client is getting items recommended for him that are in his LCP or requested by direct-care providers, set up niceties such as sensory integration items, room decor, clothing, etc. 

 

For my more mobile and independent client, I average closer to 8 hours per month as I attend his doctor appointments, advocate for him in his group home (where staff and resources are quite limited), make purchases for items he cannot obtain on his own, troubleshoot issues he may have out in the community, and support his family to avoid caregiver stress. 

 

I'm not sure if there are studies out there regarding this exact issue, but that has been my experience for the past few years. If you go on the CMSA website you may be able to post something and get the experiences of other case managers out there.

 

Take care,

Regina Pepin BSN, RN, PCCN, CLCP

Spectrum Life Care Planning & Case Management Services, LLC

Hello everyone,

Thank you for such thoughtful and valuable responses to my question. I am performing literature search but as it was noted , there is not much information available on the topic. I will continue to work on it and would love to write an article for LCP journal. I will continue needing your support and truly appreciate everyone's participation. I apologize for not responding sooner, but I had a family emergency. 

Kind regards,

Nellie 

------------------------------
Nellie Kreimer
nkreimer@msn.com
North Woodmere, NY United States
-----------------------------

Original Message:
Sent: 06-04-2015 09:58
From: Karen Roberts
Subject: case management and brain injury

I agree with Regina about the 4-8 hours per month-some months might be more some less, but I think that is a good overall long term estimate.   My main function is as a CCM and once the client reaches a stable situation there are still things that need to be done long term.  

------------------------------
Karen Roberts, RN, BSN, CCM
Nurse Case Manager
kroberts@indequest.com
Plymouth, MI United States
------------------------------


Original Message:
Sent: 06-04-2015 09:53
From: Regina Pepin
Subject: case management and brain injury

Hi Nellie,

I would say between 4 and 8 hours per month, depending on the client and  level of need. I do some private case management and have one client in a group home for medically complex, and another out in the community in a fairly independent group home.  For my complex client in a nurse-run facility, I average about 3 - 4 hours per month since the facility does the vast majority of the case management. My involvement is to act as a liaison between family and facility, make sure the client is getting items recommended for him that are in his LCP or requested by direct-care providers, set up niceties such as sensory integration items, room decor, clothing, etc. 

 

For my more mobile and independent client, I average closer to 8 hours per month as I attend his doctor appointments, advocate for him in his group home (where staff and resources are quite limited), make purchases for items he cannot obtain on his own, troubleshoot issues he may have out in the community, and support his family to avoid caregiver stress. 

 

I'm not sure if there are studies out there regarding this exact issue, but that has been my experience for the past few years. If you go on the CMSA website you may be able to post something and get the experiences of other case managers out there.

 

Take care,

Regina Pepin BSN, RN, PCCN, CLCP

Spectrum Life Care Planning & Case Management Services, LLC

Nellie

I too am interested in a basis for case management recommendations.  I am curious in spinal cord injury as well.  Please let me know if there are resources you might use, or literature / studies available.

------------------------------
Debbe Marcinko, RN, BSN, CRRN, CCM, CLCP, CNLCP, CRC, MSCC, LPC
Life Care Planner/Case Manager
debbem54@gmail.com
Pittsburgh, PA United States
------------------------------

Original Message:
Sent: 06-03-2015 22:27
From: Nellie Kreimer
Subject: case management and brain injury

Hello everyone,

I would like to know what is the criteria used by life care planners when considering inclusion of  case management services for brain injury clients in the LCP.  I realize that that the inclusion of the nurse case management services may be based on client's case and specific circumstances. I would appreciate  to hear any and all ideas.

Kind regards,

Nellie

------------------------------
Nellie Kreimer
nkreimer@msn.com
North Woodmere, NY United States
------------------------------

Original Message------

Nellie

I too am interested in a basis for case management recommendations.  I am curious in spinal cord injury as well.  Please let me know if there are resources you might use, or literature / studies available.

------------------------------
Debbe Marcinko, RN, BSN, CRRN, CCM, CLCP, CNLCP, CRC, MSCC, LPC
Life Care Planner/Case Manager
debbem54@gmail.com
Pittsburgh, PA United States
------------------------------


Original Message:
Sent: 06-03-2015 22:27
From: Nellie Kreimer
Subject: case management and brain injury

Hello everyone,

I would like to know what is the criteria used by life care planners when considering inclusion of  case management services for brain injury clients in the LCP.  I realize that that the inclusion of the nurse case management services may be based on client's case and specific circumstances. I would appreciate  to hear any and all ideas.

Kind regards,

Nellie

------------------------------
Nellie Kreimer
nkreimer@msn.com
North Woodmere, NY United States
------------------------------

Original Message------

One of the things I look at is what and how much is being done by the spouse/parent/other and try to replace it by a professional.  Also, of course, is the cognitive level of the client and complexity of needs (i.e., meds, seizures, other medical conditions, age).  And vocational issues is a whole other dimension.  If volunteer work is a factor, a voc case manager can do a lot.

Kathy

Kathryn Reid, MA, CRC, CCM
Rehabilitation Counselor & Case Manager
Reid Case Management, Inc.
www.reidcm.com  
Seattle, WA

Electronic Disclosure Statement:  This e-mail is not encrypted.  If you are communicating about a client, please do NOT place the person's name or personal information in the e-mail or subject line but use non-descriptive identifiers since this is an unsecured form of communication.  Any communication regarding a client is considered work product and will become part of the file.  If you have received this e-mail in error, please notify us immediately and remove the information from all electronic and hard copy sources.  Storing, printing, or disseminating this e-mail to other parties is prohibited unless authorized by the sender.

On Thu, Jun 4, 2015 at 7:15 AM, Debbe Marcinko via IARP Connect

Hello Peggy,
Thank you very much for your response. I find brain injury medicine very fascinating and would like to focus on working with with brain injury population. Brain injury is like a Pandora's box, you never know what you will find once you open it because each case is so unique and so complex. As you have pointed out, there may be long term consequences with brain injury which may not be apparent at the time of evaluation but which may have a significant impact in LCP consideration. I think that it is imperative to keep ourselves well educated and well informed. If you need any subcontracting services please let me know. I am having surgery next week and will need some time to recuperate but after that I am absolutely available.
Kind regards,
Nellie

Sent from my iPad


Original Message------

TBI is a significant issue in my practice - has been a special interest for many years. 

One thing to consider, is the impact that developing scar tissue may trigger SZ or other unexpected symptoms.  So allow for this kind of surprise for future consideration. 

Also, literature I've seen, suggests that AZ is going to be of increased risk for these patients - much earlier and >> percentages than in the non-injured population.  You may be able to glean updated info from your involved treating team.

One issue, kinda related, is the challenge of "missed TBI" in a trauma case; due to other challenges, the ER and other early treatment providers sometimes totally overlook this potentially serious future problem. It can cause problems with memory, RTW, family relationships, etc.

Funding will be needed as well as a strong support system.  I commend your questions and ideas for this population we are able to touch so briefly.

 

Peggy Powell, RN,CCM
Rehabilitation Consultant
Catastrophic Medical Case Manager
PO Box 621615
Oviedo, FL 32762-1615
Phone and Fax 407/365-9138

"Though we travel the world over to find the beautiful, we must carry it with us or we find it not" ~ Ralph Waldo Emerson

In accordance with the Federal HIPAA (Health Insurance Portability & Accountability Act), this e-mail/attachment may contain protected health information and is for the sole appropriate professional use of the intended recipient(s). Any unauthorized use, disclosure, dissemination, or copying of this information is prohibited. We accept no responsibility for any loss or damages suffered by any person other than the addressee as a result of decisions made or actions taken based on this communication or otherwise. If you receive this in error, please, notify the sender immediately and delete the information from your computer. Since e-correspondence is known to sometime carry a virus, and we are protected by anti-virus program, we accept no responsibility in any transmissions.

Hello everyone,

It is very interesting that Peggy has mentioned the missed TBI in the ER. My son is an emergency room physician in New Jersey. About three months ago, there was a car accident in New Jersey when  a car skidded off the  icy road, flipped over and fell down three to four stories onto a concrete pavement. Surprisingly, the young female driver and another female passenger walked away with minor bruises and aches. My son was one of the physicians in charge  of the two accident  patients. He told me that they did all the CT scans, X-rays , etc as per protocol and found nothing. The discharge diagnosis was " lucky to be alive with minor  injuries". As you may be aware, CT scans for mTBI may frequently be normal.  I thought to myself that the two young ladies may be lucky not to have life threatening injuries given the extent of the accident , but they still may have sustained a mTBI. Of course the young ladies were discharged with instructions to report any symptoms which may develop. However, frequently the symptoms may develop at a later time and the patient may not even connect the symptoms to the event if enough time has lapsed since the accident. On other occasions, even if the patient may make the connection between the symptoms and the incident, the ignorant medical professional may refer to the normal CT scan and say there is no connection between the two factors. This is exactly where we, as life care planners and educators come in. It is essential for us not to only educate ourselves but also to educate our professional counterparts, even if they are physicians. With all due respect to all professionals , sometimes our focus is too narrow and we do not see the whole picture. We also have to be very thorough during records review and patient/family  interview to spot the key information that would lead us to identification of elements that may indicate a missed  mTBI. We have to collaborate with all the involved disciplines in any given case in order to ensure that ALL problems and needs of the patient are identified and addressed. I did discuss this issue with my son as I am sure he will have many more patients who will come to his ER with a " silent brain injury". I saw the puzzled look on my son's face but I think that that he will remember what I said when he evaluates each patient. 

Kind regards,

Nellie

------------------------------
Nellie Kreimer
nkreimer@msn.com
North Woodmere, NY United States
------------------------------

Original Message:
Sent: 06-04-2015 13:44
From: Peggy Powell
Subject: case management and brain injury

TBI is a significant issue in my practice - has been a special interest for many years. 

One thing to consider, is the impact that developing scar tissue may trigger SZ or other unexpected symptoms.  So allow for this kind of surprise for future consideration. 

 

Also, literature I've seen, suggests that AZ is going to be of increased risk for these patients - much earlier and >> percentages than in the non-injured population.  You may be able to glean updated info from your involved treating team.

 

One issue, kinda related, is the challenge of "missed TBI" in a trauma case; due to other challenges, the ER and other early treatment providers sometimes totally overlook this potentially serious future problem. It can cause problems with memory, RTW, family relationships, etc.

 

Funding will be needed as well as a strong support system.  I commend your questions and ideas for this population we are able to touch so briefly.

 

 

Peggy Powell, RN,CCM
Rehabilitation Consultant
Catastrophic Medical Case Manager
PO Box 621615
Oviedo, FL 32762-1615
Phone and Fax 407/365-9138

"Though we travel the world over to find the beautiful, we must carry it with us or we find it not" ~ Ralph Waldo Emerson

In accordance with the Federal HIPAA (Health Insurance Portability & Accountability Act), this e-mail/attachment may contain protected health information and is for the sole appropriate professional use of the intended recipient(s). Any unauthorized use, disclosure, dissemination, or copying of this information is prohibited. We accept no responsibility for any loss or damages suffered by any person other than the addressee as a result of decisions made or actions taken based on this communication or otherwise. If you receive this in error, please, notify the sender immediately and delete the information from your computer. Since e-correspondence is known to sometime carry a virus, and we are protected by anti-virus program, we accept no responsibility in any transmissions.

Hello Peggy,

Thank you again for responding to my posting on IARP back in June regarding criteria used by LCP to include case management services in a life care plan. I am still working on the topic and I was wondering if it would be too much trouble to ask you to fill out a questionnaire and forward it back to me. Thank you very much for your time and feel free to contact me if you have any questions.

Respectfully,

Nellie

------------------------------
Nellie Kreimer
nkreimer@msn.com
North Woodmere, NY United States
------------------------------

Original Message:
Sent: 06-04-2015 13:44
From: Peggy Powell
Subject: case management and brain injury

TBI is a significant issue in my practice - has been a special interest for many years. 

One thing to consider, is the impact that developing scar tissue may trigger SZ or other unexpected symptoms.  So allow for this kind of surprise for future consideration. 

 

Also, literature I've seen, suggests that AZ is going to be of increased risk for these patients - much earlier and >> percentages than in the non-injured population.  You may be able to glean updated info from your involved treating team.

 

One issue, kinda related, is the challenge of "missed TBI" in a trauma case; due to other challenges, the ER and other early treatment providers sometimes totally overlook this potentially serious future problem. It can cause problems with memory, RTW, family relationships, etc.

 

Funding will be needed as well as a strong support system.  I commend your questions and ideas for this population we are able to touch so briefly.

 

 

Peggy Powell, RN,CCM
Rehabilitation Consultant
Catastrophic Medical Case Manager
PO Box 621615
Oviedo, FL 32762-1615
Phone and Fax 407/365-9138

"Though we travel the world over to find the beautiful, we must carry it with us or we find it not" ~ Ralph Waldo Emerson

In accordance with the Federal HIPAA (Health Insurance Portability & Accountability Act), this e-mail/attachment may contain protected health information and is for the sole appropriate professional use of the intended recipient(s). Any unauthorized use, disclosure, dissemination, or copying of this information is prohibited. We accept no responsibility for any loss or damages suffered by any person other than the addressee as a result of decisions made or actions taken based on this communication or otherwise. If you receive this in error, please, notify the sender immediately and delete the information from your computer. Since e-correspondence is known to sometime carry a virus, and we are protected by anti-virus program, we accept no responsibility in any transmissions.