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Case managers and lawyers – the power of collaboration amid Covid-19

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The Covid-19 epidemic has had a disproportionate impact on societies most vulnerable, due to social, financial and medical needs, write legal executive Jack Sales and clinical case manager Alexandra Hitchcock…

With many clients falling into this category case managers and solicitors have needed to continue to work in a collaborative and responsive fashion in order to best respond to the clients’ changing needs.

This is compounded when the client is not the only person in the household and  their care team’s needs also need to be considered.

Elderly family members and those with other medical conditions along with roommates working from home, children requiring home schooling and regular paid carers needing to self-isolate have made supporting clients’ needs more challenging.

This has required the breadth of consideration to be widened to ensure revised planning takes into account the needs of all involved, while keeping the client as the central focus.

Urgent need has often required initial reliance on social services and charities with mid to longer term support coming with solicitors accessing interim payments or additional services.

Increased funding to social services and charities has been beneficial to fill this void, such as food deliveries to people in need, volunteers collecting basic necessities and telephone support for those experiencing loneliness. However other services, such as home repairs and modifications have been delayed in the current crisis.

Having funding available to follow on when statutory or charity services cease is as important as the duration of these services is unknown and clients may not have the capacity to react.

The introduction of government restrictions has required a delicate balance of risk assessments to determine the clients’ health and financial support needs.

When clients require medical, case management and/or expert witness appointments to be completed in order to not only further their health but support their claim, a decision must be made as to whether the need falls within government guidelines and the level of risk of potentially introducing coronavirus into the household.

With many appointments suddenly not available, cancelations through the NHS and uncertain waitlists in the independent sector finding the best and safest fit for clients has required consistent review, understanding and close working by all involved.

Rehabilitation has been noticeably slower with a downturn impact on clients’ mental health, including low mood related to social isolation or anxiety related to the pandemic, slowing momentum for many who were previously progressing.

With rehabilitation planning taking clients’ clinical need and motivation into account, case managers have needed to work closely with clients, rehabilitation teams and solicitors to determine if continuing, delaying or ceasing treatment is the best option.

Although beneficial, some clients have been reluctant to utilise remote rehabilitation sessions or have found that they are less able to connect with therapists via video or telephone.

This has led to some choosing to wait for face to face appointments to become available at the risk of pausing or reverting aspects of their rehabilitation.

Other clients have managed remote sessions well with online appointments likely to have a permanent place in their continued rehabilitation and they require less travel and cost than face to face appointments.

As government restrictions lift but the potential for a second wave of Coronavirus looms, the client/case manager/solicitor relationship will continue to evolve as we progress rehabilitation in unprecedented times while keeping the clients current and long-term needs at the forefront of their rehabilitation plans.

Legal team

Instructing a case manager is one of the first acts of the instructed legal team. Under the Rehab Code, the focus of the legal claim should be on rehabilitation at an early stage.

Often, case managers will work with clients over many years and it is vitally important to get this working relationship right as soon as possible.

They will need to be a “good fit”, have the right expertise and crucially be able to pro-actively progress the client’s rehabilitation and find solutions when they come across obstacles.

There have been few greater obstacles to rehabilitation than Covid-19 and the social distancing measures introduced which have given rise to additional barriers to rehabilitation for already vulnerable clients.

The past few months, even with some easing of restrictions, have had a significant impact on the availability and accessibility of much needed treatment for injured clients.

Whether it has been a barrier to getting rehabilitation off the ground in the crucial early stages of recovery or the setback of an interruption to an existing rehabilitation package, the impact can be felt acutely and can be a serious obstacle on the clients’ road to recovery, both physically and psychologically.

This can be compounded by social isolation for those living alone or additional strain on family relationships in what can already be a difficult set of circumstances following a life changing injury.

Many therapists have been able to use the benefit of available technologies to offer remote sessions to mitigate the impact of Covid-19 but this is not suitable for all therapies and not possible for some clients who do not have the availability of, or capacity to use, such technologies.

This creates a “black hole” of much needed treatment for many clients. Additionally, although some of the current challenges may be shared by clients, often their needs are unique meaning there is no “one-size-fits-all” approach that can be applied.

As a result, it is more important than ever for the legal team and the case manager to work closely and pro-actively together to find alternative and innovative solutions to these problems.

This is not limited simply to rehabilitation but the need to ensure even the most basic needs can be met for the most vulnerable clients, such as charities who can provide and deliver groceries to those who are vulnerable, shielding and on low incomes.

It is often the case manager who is on the front line, seeking solutions to problems, finding alternative ways of delivering rehabilitation and attempting to increase a client’s independence and quality of life, but it will require the expertise of the legal team to secure funding, primarily by way of interim payments, to ensure positive solutions can be put into effect without delay.

Clients may also require assistance with financial advice to address any concerns about their ability to meet outgoings such as rent, mortgage payments and utility bills. This may be provided by way of advice from a financial planner, for example, or the use of charities that can provide guidance and assistance with financial concerns.

The legal team can also consider the need for securing larger interim payments to cover the increased costs of care in these times; including the additional costs of ensuring that all necessary Personal Protective Equipment is available.

In addition, the collation of the supporting clinical records by the legal team can play a huge part, not just in securing funding, but in allowing medico-legal experts to assess the full picture when recommending treatment and further needs. This in turn can be crucial in ensuring clients receive the best compensation to meet their long-term needs.

A collaborative approach by the legal team and the case manager has never been more important than here and now to ensure the client remains at the forefront of everything we do and to maximise their recovery.

Case study

We recently worked together on a case where a client has been faced with the types of challenges outlined above.

The client suffered a lower limb orthopaedic injury restricting his mobility.

He also suffers with psychological symptoms including low mood, anxiety, suicidal ideation and outbursts of anger which impact on his thinking and engagement in activities of daily living.

The client lives alone and has little by way of a support network in the local community other than a care package provided by the Local Authority.

His rehabilitation was due to commence just as the lockdown struck in March 2020. The client was left isolated, unsure of his welfare and unclear of the impact on his rehabilitation.

Working collaboratively and proactively, Irwin Mitchell and Bush & Co Rehabilitation were able to support the client and find solutions to the unprecedented challenges posed by Covid-19.

In case management terms, we were able to identify local charities who could deliver groceries to the client who was shielding. Psychological and physiotherapy support was sourced independently as the client has difficulty engaging in statutory service virtual provision.

On the legal front, we were able to ensure the client’s legal claim enabled there to be funding available under the Rehab Code to allow Bush & Co Rehabilitation to implement treatment. There were also regular telephone calls with the client to discuss his needs and keep him updated on actions being taken to ensure the client was a part of the process.

The client was unable to engage in video assessments and so telephone assessments were arranged. It became apparent the client’s psychological presentation meant he had difficulty engaging in any remote appointments without significant support provided by someone else in the home.

Therefore, with some easing of restrictions, face-to-face assessments were arranged. This required the need to risk assess and ensure Personal Protective Equipment and safeguarding measures were followed.

Despite the obstacles posed by Covid-19, these were not allowed to be a barrier to the client’s rehabilitation. The client has remained motivated to engage in the rehabilitation process and any disruption and delays caused by the lockdown have been mitigated to ensure motivation and engagement levels are maintained.

Jack Sales is a legal executive specialising in serious injury cases at Irwin Mitchell. Alexandra Hitchcock is a clinical case manager at Bush & Co Rehabilitation.

Case management

New chair of BABICM appointed

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A new chair has been appointed by the British Association of Brain Injury and Complex Case Management (BABICM).

Vicki Gilman has taken over at the helm of BABICM, which is the representative body for continued professional advancement of case management and promotes best practice in supporting people with brain injury and complex conditions.

She takes over from Angela Kerr, who steps down after five years in the role at the helm, in what is BABICM’s 25th anniversary year.

“I’m delighted to be BABICM’s new chair in our 25th anniversary year.  The organisation has a well-established, powerful and influential voice and we will continue to ensure that the needs of people with brain injury and complex medical conditions are recognised and met,” says Vicki.  

An experienced case manager, health entrepreneur and clinical specialist neurophysiotherapist, Vicki is currently managing director of Social Return Case Management, a company she established over six years ago.

She qualified in physiotherapy at King’s College, London and completed a Master of Science degree in neurorehabilitation at Brunel University.  

For several years, Vicki worked in a specialised military neurorehabilitation unit, treating adults with brain injury, spinal cord injury, and other complex conditions.

Vicki coordinated and worked clinically in NHS and independent sector multidisciplinary community teams treating people with neurological conditions, and she was an expert witness in brain and spinal cord injury for over 20 years. 

Her work in a multidisciplinary team steered her into case management, and for six years Vicki was on the BABICM Council and chaired its training events group, returning last year to BABICM Council for a preparatory year before stepping into the role as chair.

“These are challenging and changing times for everyone in healthcare and beyond,” continues Vicki.  

“As case managers we need to be flexible but quick to respond to new developments and ways of working, ensuring the best possible outcomes for our clients. 

“As an organisation, BABICM has to be responsive to the needs of our members; we must ensure that they receive the training and support required to maintain our high professional standards and to deliver best-practice services.”    

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Case management

Awards to recognise role of case management during pandemic

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An awards event is being held to recognise and reward the role of case management during the COVID-19 pandemic. 

CMSUK is holding its first-ever virtual awards event, which will bring together industry professionals from across the country to reflect on the impact of the pandemic on case management practice. 

The ‘Acknowledgement of Achievement Awards; How the Pandemic Has Changed Case Management Practice’ event has four categories which will allow case managers and businesses the opportunity to review their work and achievements. 

The event, on Friday, September 24, will build further on CMSUK’s commitment to case managers during the past year, during which it delivered a comprehensive offering in online education through an array of lunchtime webinars and study days, culminating in the industry’s first online conference. 

Education and development is currently more vital than ever in case management, with the upcoming launch of the Institute of Registered Case Managers (IRCM) requiring case managers to evaluate heir learning and experiences to shape their professional development and practice.

“We didn’t have an awards event last year, and while we wanted to do something this year, the board felt we needed to do something a bit different,” Niccola Irwin, director of CMSUK, tells NR Times. 

“This will be an opportunity to reflect on how COVID-19 has changed case management. In the submissions, we are asking for reflection on how the pandemic has changed their practice, which will also allow for sharing and showcasing good practice. 

“Case managers have always been very creative and tenacious, and those strengths were never more needed than when the pandemic came and the circumstances were very different. But I think through reflecting on that time, looking at what we did and what we could do differently, will result in an even stronger offering to clients, customers and staff. 

“The awards this year have been pared back a little bit, we have four categories, but we are so pleased to be able to reflect on the past year in this way, in what we hope will be a very nice event as well as a chance to celebrate.”

Categories open for nomination are: 

  • Clinical Case Manager of the Year – Catastrophic
  • Clinical Case Manager of the Year – Moderate/Severe
  • Case Manager Supporter of the Year
  • Case Management Company of the Year

Shortlisted nominees will be invited to present their short reflection at the online networking and award event.

Visit CMSUK here to find out how to nominate, sponsor the awards and book a place at the event. Nominations close on Friday, June 25.

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Case management

Case managers praised for vital work during pandemic

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Case managers have won praise for the “vital role” they have played in their response to the COVID-19 pandemic.

New research has found that 81 per cent of claimant personal injury solicitors believe case managers have risen to the challenges presented by the pandemic.

Solicitors credited case managers for “adapting to an unprecedented situation”, “transitioning to remote working”, “developing bespoke solutions”, “ensuring rehabilitation continued seamlessly” and “facilitating remote rehabilitation”.

The research, by barristers Exchange Chambers and neurorehabilitation centre Calvert Reconnections – a first-of-its-kind brain injury rehabilitation centre in the UK, which opens next month – reflects on a period during which case management had to find alternative ways to provide its services to clients to ensure support continued. 

“This research is well-deserved recognition for the vital role case managers have played during the Covid-19 pandemic.  They’ve worked proactively and innovatively to ensure the most effective outcome for their clients,” says Bill Braithwaite QC, head of Exchange Chambers and a trustee at the Lake District Calvert Trust.

Calling for ever closer working relationships between lawyers and case managers, Bill added: “I’ve always thought that a good case manager was the key to a successful outcome for the injured person, the family, and the compensation claim.

“If you appoint a good case manager early, and that person has the ability to get to know the family, gain their trust and confidence, and help to manage the stormy voyage through recovery and rehabilitation, that person will be an invaluable contact point for the solicitor, frequently helping him or her to avoid disturbing and distressing the family.

“So much of the litigation is bound up with the injured person and the family, and the plan for life.

“Further developing the relationship between the two professions would inevitably improve standards all round.”

Heather Batey, neuro OT, managing director of reach and trustee at The Lake District Calvert Trust, spoke of the vital role case managers have played in supporting clients.

“Over the past 12 months, the health and wellbeing of many TBI patients has been in the hands of case managers who have been supporting their patients and sourcing services as required while being the ‘go to’ point for families,” she says. 

“Throughout the pandemic, it has been a difficult role to navigate, but by using their clinical reasoning skills and thinking ‘outside the box’ in such extraordinary circumstances, they have successfully ensured that treatment has progressed, generally remotely.  

“They’ve also supported their patients’ mental health, which has been paramount.

“Case managers have also been excellent in sourcing iPads, laptops and smart phones for their patients, which has enabled rehabilitation to progress successfully. 

“I totally agree that a good case manager is key to ensuring a successful outcome for a TBI client and their family. I work with case managers and with almost every patient we have seen excellent practice, great communication and holistic problem-solving skills coming to the fore.”

Jackie Dean, clinical director at N-Able Services, also welcomed the findings.

“It is my experience that case managers have advocated for their clients, have ensured that services have continued, both remotely and in person where required, and with appropriate PPE,” she adds. 

“Risk assessments have been conducted and, as is the strength of case management, problem solving has taken place around staffing, mental capacity and continuation of therapy in the community.”

 

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