Supporting workers through Post-Coronavirus (COVID-19) Recovery

Workers are still feeling the effects of COVID-19: There is a new program to help!

In early September (2020), the United States surpassed 6 million[i] cases of COVID-19 reported to the Centers for Disease Control (CDC). Since March, the U.S. has witnessed the diagnosis exponentially increase around the country, some diagnosis resulting in death (approximately 200,000 nationwide[ii]), yet the vast majority of those diagnosed (nearly 97%) recover. Within the population of those who recover the effects of the virus on their body ranges from asymptomatic to a wide variety of lingering ailments. The American Association for the Advancement of Science, in their ‘Science’ journal report “Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain.[iii]

So, what’s next for those who return to work? In this INSIGHT article, we partner with Physical Therapist Nicole McManus, MSPT, OMT, FAAOMPT of Professional Physical Therapy (ProPT), a provider of outpatient therapy services with a passion and dedicated program for injured workers to examine the impact of reconditioning after being diagnosed with COVID. ProPT recently added a Post-COVID Reconditioning Program to their service line which is focused on systematically preparing the worker to tolerate the demands of their job.

Post-COVID effects include limited cardiovascular endurance, muscle weakness, low VO2 max (respiratory capacity) and in some cases, cognitive processing deficits and depression as a result of post-intensive care syndrome (PICS).  If a worker needs to be able to perform physically demanding tasks over the course of a normal work day, there is a strong possibility that without reconditioning, the worker will fail to meet the job requirements and may need to remain on restrictions.

Professional Physical Therapy uses a validated pulmonary conditioning protocol to address the adverse effects of COVID-19.  The worker is evaluated by a licensed physical therapist who not only assesses the impairments and functional deficits present but takes specific measurements regarding their pulmonary and cardiovascular function.  These key measurements are reassessed regularly to monitor progress and to compare their current abilities to the job requirements.  The benefit of a specific reconditioning program for the affected worker is that they can also see and feel their progress.  Injured workers who participate in this program have less anxiety or reservation when it is time to return to work as reconditioning allows them to practice their job tasks while consistently increasing their cardio-pulmonary endurance and capacity.

References: 

[i] CDC COVID Data Tracker, retrieved from https://covid.cdc.gov/covid-data-tracker/?utm_source=morning_brew#cases

[ii] COVID in the U.S.: Latest Map and Case Count, retrieved from https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

[iii] From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists, retrieved from https://www.sciencemag.org/news/2020/07/brain-fog-heart-damage-covid-19-s-lingering-problems-alarm-scientists

case management during coronavirus

Caring in the midst of a crisis: Re-examining workers’ compensation case management during COVID-19

In the wake of COVID-19 healthcare professionals worldwide are experiencing drastic changes in how they work and care for their patients – changes which not only impact hospital and acute care professionals,  but changes with rippling impacts to health care providers in varying fields including nurse case management. Whether facing a global pandemic, or an equally significant crisis, the ability to adapt is critical for patient recovery and care. After more than a month of shelter-in-place protocols, MLCC takes a moment to re-examine workers’ compensation nurse case management and how we’re ensuring our patients continue to receive the attention and care they need for recovery.

As workers’ compensation, or field nurse case managers, our primary role is not direct care. Instead we are commissioned to assess, plan, facilitate, coordinate care, evaluate and advocate options and services to meet an individual’s and family’s comprehensive health needs.[i] During a crisis, our mission does not change yet, how we deliver and manage our cases just might. Within workers’ compensation, we’re often treating individuals with emergent injuries or illnesses, and elective treatments may not appear critical in the face of those directly affected by the crisis. However, our goals remain focused on the improvement and healing of our patients, and here’s how we’re doing it:

1. Finding alternative methods of treatment

Our patients and the care they need is our priority. When customary modes of treatment are not available, nurse case managers must find alternative solutions such as replacing in-office provider visits with telehealth visits and video appointments. Physicians, physical and occupational therapist are still able to provide orders, update treatment plans, provide treatment, and more through video conferencing features of telehealth software platforms.

2. Finding alternative care providers and alternative methods of care delivery

As nurse case managers within workers’ compensation, finding alternative care providers and alternative methods of care delivery is something we do every day in practice.  When one door is closed there is always another that is open. At MLCC, once regional shelter-in-place and stay at home orders were executed we immediately developed an evolving list of providers that were open and confirmed the level of services they had available. If certain caregivers were closed and unavailable, alternative treatment sites and treatment providers were identified.

telehealth in workers' compensation case management

For our existing patients, we immediately reassessed diagnosis and whether any new complications or risk for complications were identified while continuing treatments put in place by their care providers through video appointments and telehealth conference calls.

When new patients were referred, with new or evolving injuries/illnesses, physicians were identified, and visits facilitated as needed. As with all patient visits during this time of crisis, appointments were completed in person with appropriate personal protective equipment (PPE) or through telehealth platforms and video conferencing until the pandemic is under control.

3. Exploring varying options for testing

During times of crisis usual and customary standards of care and case management may not be available. In the Northeast region we found that provider offices may be closed for patients, but open for specific services, or even transformed into COVID-19 testing centers. As case managers we rely on our relationships with our providers and are consistently exploring the varying options available to our patients.

Let’s consider an example case where a patient who has been diagnosed with a fracture and needs an evaluation of the injury. The evaluation has been delayed due to the shutdown of offices but can no longer be postponed. Even though the physician’s office is closed, their x-ray office may be open, and their treating physician is requesting an x-ray.

However, amid the current crisis the x-ray department is now a known COVID-19 evaluation and treatment center. That patient, who is severely compromised, may be put at risk in that center. An alternate site would be found, orders facilitated, and the treatment scheduled by the nurse case manager to decrease risk of the patient contracting COVID-19.

Having the ability to continue managing our cases and securing varying options is the responsibility of the nurse and by doing so decreases the anxiety the patient may have around their treatments and care.

4. Connecting patients with the appropriate resources

As health care professionals, our focus always includes the prevention of further complications, or contamination in the case of COVID-19, of patients and their families while getting them resources and services they need for recovery. In the wake of the current pandemic this includes nurses wearing appropriate PPE’s and taking precautions during patient visits, at therapy appointments, or out in the community.

personal protective equipment

It also means connecting our patients with protective equipment, masks and gloves, when attending appointments in their physician’s or provider’s office. Continuing to educate and provide supplies goes a long way in minimizing risk of possible contamination.

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