In acute care settings, professional case managers with nursing, social work, or other health and human services backgrounds regularly encounter patients who need clinical care following a severe or even catastrophic injury, whether occupational (e.g., a work-related injury) or nonoccupational (e.g., a car accident) in nature. During a patient's hospital stay, the clinical priority is achieving maximum medical improvement (MMI). Postdischarge from acute care, the patient transitions to subacute care and/or rehabilitation. For many hospital-based case managers, this is the extent of their view of the care continuum.
Although the focus on postsurgical recovery and MMI is completely appropriate in the hospital setting, there are other questions to be considered, well beyond the transition to the next level of care: What comes next for this patient (also known as the "client" receiving case management services) after rehabilitation? What are the patient's ultimate goals, including returning to work or full-time schooling?
As case managers across the health care spectrum strive to provide holistic, person-centered case management, they must challenge themselves to look beyond a particular episode of care. Even hospital-based case managers who have no expertise in vocational services or workers' compensation should consider goals such as returning to work as they devise and implement a care plan. This is in keeping with the Code of Professional Conduct for Case Managers, which requires board-certified case managers to undertake a comprehensive assessment of the individual's needs and to identify options and provide choices when available and appropriate (Commission for Case Manager Certification, 2015). Among the options available to support return to work is disability management.
Disability management, a professional practice that includes a nationally accredited certification (Certified Disability Management Specialist or CDMS), specializes in return-to-work and stay-at-work programs for individuals who sustain an injury or illness, as well as disability prevention. Disability management specialists have the knowledge and expertise to facilitate and support an individual's safe return to the workplace (Scotton, 2017). Large employers, in particular, offer disability management services to employees with both occupational and nonoccupational illnesses and injuries, enabling them to transition back to the workplace.
Consider the example of "Charlie" who worked for an engineering firm as a surveyor's helper. While driving back from a remote site at night, Charlie was involved in a car accident and sustained a severe leg injury requiring surgery and rehabilitation. Because of the injury, Charlie could no longer climb hills and walk on uneven terrain, all of which were part of his surveying work in the field.
The employer valued Charlie's skills and dedication and created a clerical position for him. At first, fatigue and other physical issues limited Charlie to part-time work. But as he got his strength back, Charlie could work longer hours, although he was never able to resume surveying work. Nonetheless, what mattered most to him was returning to productivity and reconnecting with his friends and colleagues at work.
In cases such as Charlie's, coordination between the hospital-based case manager and the disability manager helps ensure the return-to-work process is initiated as soon as possible. One way is utilizing the ill/injured person's job description to direct the physical therapy and occupational therapy he or she receives, as well as work hardening that will help him or her recuperate. As the employee approaches discharge, specifics of the job requirements can help inform what accommodations might be necessary to facilitate a return to work.
Such collaboration between case managers and disability managers already exists in workers' compensation case management. Their multistage case management process includes coordinating the involvement of specialists in areas such as vocational rehabilitation and disability management to enhance the potential for return to work (Case Management Body of Knowledge, 2017). It is unusual, however, for hospital-based case managers to work as closely with a specialist in vocational rehabilitation or disability management as workers' compensation case managers do. Nonetheless, having knowledge about disability management allows case managers to consider additional resources for longer term care planning, well beyond discharge or transition to a subacute care/rehabilitation. Indeed, a best practice for case managers is to work closely with a disability management specialist.
Case managers in acute care can and should participate in an important aspect of long-term recovery for individuals suffering severe injuries or illnesses that impact their ability to work: early intervention. Best practices in disability management show that early intervention increases the efficiency and appropriate expediency of the return-to-work process. Moreover, having contact with the employer while the ill/injured employee is recovering-even while he or she is still in the hospital-helps the individual feel cared for and that his or her contribution is valued (U.S. Department of Labor, n.d.). The purpose is not to push the employee back into the workplace; rather, it lets the individual know that interventions and expertise exist to help facilitate return to work.
The question on the minds of hospital-based case managers may very well be: What does this look like within our practice? It can be as simple as asking a patient about his or her work status and occupation as part of in-take and assessment. If the individual has been severely or catastrophically injured (e.g., an amputation), talking about his or her job soon after the injury occurs may not be the optimal timing. It is common for people to experience grief, anger, and other strong emotions following a life-altering injury. However, as recovery progresses, discussions between the case manager and the patient can help ascertain the importance of work and being productive to that individual. In addition to salary and other financial aspects, work is recognized as a social activity, providing contact with peers, which also helps promote health and well-being.
By tapping into these positive associations with work, the hospital-based case manager can help set the tone for the individual to embrace returning to work. Knowing that there are potentially numerous options for facilitating return to work, including the services of a CDMS or other experienced professional, a person who has been severely injured or who has a disability can gain a broader view of what the future might look like. Even though this kind of thinking may stretch case managers in some practice settings such as hospitals, to be truly holistic in their approach, they must extend their sights beyond the clinical to also consider the vocational needs of the individual.
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