Recently in Complex Care Tip Series Category

Yes, Virginia, there is a proper way to speak to or about people with disabilities. No matter what you do, brushing up on your communication skills is always a good idea. For a full primer on proper etiquette for speaking to or about people with disabilities, visit the U.S. Department of Labor, Office of Disability Employment Policy and review Communicating With and About People With Disabilities.

Generally speaking, it is important to always speak affirmatively and place emphasis on the person, not the disability. When working with a person who has mobility impairment, pull up a chair and put yourself at the user's eye level to make communication with the person more comfortable.

The three most important things to remember when communicating with a person who has a disability:

1 - Relax.

2 - Treat the individual with dignity, respect and courtesy.

3 - Listen to the individual.

And for your viewing pleasure, watch this short video by Darlene O'Brien, founder of Blind Ambition, a consulting and training business that provides disability etiquette training. According to Darlene, the community of disabled individuals is the largest minority in the U.S. and one that will continue to grow exponentially in the coming years...

Are you involved in managing the care of injured workers who are wheelchair bound? If so, there are many adjustments that should be made to ensure a claimant's home is both safe and accessible. Many details often go overlooked and can severely limit a person's ability to access their own home. This could lead to depression and other complications that result in added claims costs and potential attorney involvement. 

Zack Craft, vice president of rehabilitation technology and complex care for Total Medical Solutions, recommends a thorough review of the claim at the onset to ensure the claimant's needs are met and to minimize costs and legal issues over the life of the claim. Zack offers this checklist for adjusters, nurse case managers and others who are involved in managing the care of injured workers as a helpful guide:

Inside the home

1. Clear pathways throughout home. All travel paths including doors and hallways should be clear and a minimum of 32" wide;
2. Remove loose carpeting or rugs;
3. Furniture placed 32" apart. All furniture pieces should be placed a minimum of 32" apart to allow easy wheelchair access; consider space in each room for turning the wheelchair -- minimum of 5 foot radius needed;
4. Doorways are 32" wide. If the doorway can't be widened, consider installing offset hinges that allow the door to swing completely clear of the opening;
5. Threshold ramps installed. For sub-level homes, this allows access to to all rooms in the home as well as the car garage;
6. Kitchen tips: appliances should have front controls; clear furniture from travel paths and ensure 32"-wide path all around; ensure access to an easy grasp reacher to allow access to items that are in cabinets or out of reach;
7. Laundry room tips: ensure front-loading washer and dryer; door swings should not obstruct pathway;
8. Bathroom tips: shower should be big enough to accommodate a wheelchair - minimum 5 foot radius; wall-mounted or pedestal sink; consider whether a transfer bench, roll-in shower or rehab shower chair is needed; install a hand-held shower head; diverter valve installed to allow either overhead shower or hand-held shower; hand rails installed for transferring to/from toilet;
9. Bedroom tips: super pole installed from ground to ceiling next to bed allows for transfer support; all-in-one commode next to bed; home care beds can also be placed in a living room with all-in-one commode if bedroom does not accommodate;
10. Safety exits: ensure at least one, but preferrably two doors in the home are designated and set up as emergency exits for the wheelchair user.

Outside the home

1. Doorways should be a minimum of 32" wide; if doorways are narrower than this, they should be widened;
2. Ensure easy access in and out of the home. Install at least one ramp to an entry/exit of the home; aluminum ramping is preferred and is a must for mobile homes and trailer homes;
3. All sidewalks should be leveled and made from concrete; no gravel walkways;
4. Vertical platform lifts should be used in homes located in flood zones, if decks are installed and/or in tight spaces such as a courtyard.
5. Mailbox relocated for easy access.

For your reference, here are the current design guidelines as set forth by the Americans with Disabilities Act (ADA).

This checklist is meant to be a starting point for consideration on your claims. Total Medical Solutions suggests working with an experienced rehabilitation specialist to ensure claims are appropriately managed. 

Ever consider the impact of smoking and how it affects your complex claims? What about what it does to medical equipment? Zack Craft, vice president of rehabilitation technology and complex care, thinks smoking is an important element of care -- one that requires attention and consideration at every stage when managing complex claims.

See What's In A Cigarette by American Lung Association

Second-Hand Smoke Facts

• Second-hand smoke is a major air pollutant
• Second-hand smoke includes upwards to 4,000 chemicals
• Second-hand smoke includes 200 known poisons including formaldehyde and carbon monoxide
• Second-hand smoke contains 43 carcinogens
• Men (about 24%) smoke more than women (about 18%)
• About 31% of people who live below poverty level are smokers

Visit the CDC.gov website called Vital Signs for more information on Tobacco Use and Second-hand Smoke

Why is Smoking Important in Complex Care cases?

• It negatively impacts the healing process
• Wounds take longer to heal, or may never heal
• Longevity of medical equipment should be considered
• Carriers should anticipate additional claim costs

See Smoking and Wound Healing: A Guide for Surgical and Burn Patients by University of Wisconsin's School of Medicine and Public Health

Steps You Can Take

• Incorporate questions into the assessment process in order to identify and manage claims where smoking may be an issue
• Educate all involved in patient care about smoking and the health risks involved; include case managers, adjusters, home health care providers, patients and family
• Consider the impact of smoke on medical equipment to anticipate future costs of replacing equipment
• Evaluate claims where smoking is an issue regularly to assess: quality of care, treatment options and equipment needs

For more information on managing claims involving smoking, contact Total Medical Solutions, your complex care provider.

Does your claimant need disability ramping installed to access their home? Having ramping or other home modifications installed for injured workers is a big responsibility. And costly. The next time you need to purchase or install ramping for a claimant, Cara Barde, President of Total Medical Solutions, encourages you to consider the benefits of aluminum over wood:

Aluminum Ramping:

1. Maintenace Free
2. Does not rust or decay (aluminum lasts for 100+ years)
3. Easy assembly with minimum tools
4. No building permit required
5. Can easily be expanded, reconfigured or moved
6. Aluminum ramping is an asset that can be reused, resold or rented
7. Installed in less than an hour!
8. No environmental impact

Wood Ramping:

1. Requires regular maintenance
2. Will rot or decay over time
3. Must be installed by a contractor or carpenter (increases costs)
4. Requires a building permit (increases costs and time)
5. Reconfiguration must be made by demolition and reconstruction
6. No resale value; could actually lower the value of the home
7. Typical installation takes 2 to 3 days
8. Could include dangerous chemicals or applied treatments

As you can see, there are many benifits to using aluminum vs. wood disability ramping. In addition to the benefits of using aluminum ramping as outlined above, when you purchase your ramping through Total Medical Solutions, you can:

• "Bank" your aluminum ramping - when it is no longer being used by your claimant, the insurance carrier can reuse the ramping for future claimants for a substantial cost savings
• Rent aluminum ramping for temporary needs
• Reconfigure aluminum ramping sections to fit any home
• Easily move aluminum ramping to a new home if your claimant moves
• Rest assured that the aluminum ramping we sell is dependable, durable and American made

For more information about aluminum disability ramping, anytime, anywhere you need access, please contact Total Medical Solutions at 1-800-700-9393 or visit www.NewTMS.com

Are you involved in the clinical management of catastrophic claims? If so, it is important to establish a checklist to ensure you consider all the needs of the injured worker. Having a checklist will help you cover all the necessary bases and aid you in providing the right level of care.

Kevin Glennon, Vice President of Clinical Services for Total Medical Solutions, suggests the following checklist as a tool to help in the clinical management of catastrophic claims:

1. What is the level of injury and resultant deficit in functional ability?
2. What are the basic equipment needs of the injured worker?
3. What soft goods (daily supplies) are needed to complete daily living skills?
4. Are there any home modifications / accommodations that need to be implemented?
5. Identify any specific concerns that are associated with the level of disability.
6. Will the injured worker need assistance on a daily basis? If so, for how many hours? What level of home care does the patient need?
7. What are the ongoing medication needs? Will they change? If so, identify intervals for re-evaluation.
8. Is the patient obese? Consider the physical changes that may occur and be ready to adjust care / needs accordingly.
9. What clinical care partners do you need to engage to ensure the best treatment results for your patient?
10. Identify regular intervals for re-evaluating the needs of your catastrophic claim patient.

Kevin also highly recommends finding a clinical care partner that specializes in catastrophic claim management for workers' compensation patients. Total Medical Solutions coordinates case and clinical strategies to ensure the most appropriate, yet cost-effective treatment plans and results. Your clinical care provider should be an integral partner in the advancement of positive outcomes for your injured workers.

For more detailed information on the clinical management of catastrophic workers' compensation claims, contact Total Medical Solutions at 1-800-700-9393 or visit them online at www.NewTMS.com