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Babysitting With a Purpose

In the 20+ years I've been a case manager, I've certainly seen employers grow to embrace the idea and benefit of light duty work.  In the 1990's the Safety Director at one factory used to say "if the employee can't lift more than 10-lbs., they can't open our door to get in - We don't have room to babysit!"   Staff changes have come and gone several times since then, and the mindset of the company has totally changed now to one of accommodating pretty much any restriction in order to avoid lost time as long as it is in the best interest of the injured worker. 


Right now, Kelli Wells, RN has an injury case with that same company that demonstrates how light duty can benefit everyone involved.  The injured worker sustained a bump to his shin that he didn't think was significant.  Within a week, it became apparent the resulting wound was not healing adequately, and the IW was referred to a general practitioner, who recommended referral to a wound specialist.    This is where Case Management referral was received.

Kelli assessed some potential barriers to healing:  obesity (300-lbs), use of smokeless tobacco, and untreated hypertension.  Soon, the barrier of noncompliance would come into play - continued nicotine use (impedes vascular bloodflow), scratching/picking at the wound (bacteria introduction), taking his meds inconsistently, removing bandages prematurely, etc. - Kelli has had her hands full.  But he was still working regular duty!  

After six weeks with the wound specialist, healing progress was still very slow, and the MD recommended IW to keep his legs elevated for all but 1-2 hours per day.  Many times this would indicate an "off work" status, however his employer was concerned about noncompliance (ya think?) with restrictions at home.  After a team conference, Kelli was able to negotiate a LD RTW with 9 of 10 hours keeping the leg elevated above the heart.  That would never have happened if there'd not been a case manager on the file, or if there'd not been an employer willing to "babysit" an employee for 9 out of 10 hours to assure compliance for a large part of the day.  

Now two weeks later, the wound appears significantly improved, indicating the treatment plan is on track.  Work restrictions have been relaxed a bit, to allow more activity.   What's the value of the case manager? The employer is benefiting by avoiding lost time, the injured worker is benefiting by healing and progress toward return to normal activities; and the carrier is benefiting from lower expenditures (no TTD, shortening length of treatment, and decreased treatment needs).  All from babysitting.  I guess we're never too old to babysit - or have a babysitter!
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