By Thomas J. Sheppard
A primary objective of workers compensation (WC) medical coverage is to return an injured worker to their pre-injury state as quickly as possible. In more severe cases, returning the worker to pre-injury status may:
- Be difficult
- Require multiple surgeries
- Include extended periods of hospitalization and rehabilitation
The most seriously injured workers may need medical care for the rest of their lives. Post-acute care at home or in a facility may be part of an overall plan to restore and maintain quality of life for injured workers who are not yet able to return to work. Post-acute care is an especially prominent part of long-duration WC claims.
What Is Post-Acute Care?
Post-acute care, as defined by the Medicare Payment Advisory Commission,1 includes:
Rehabilitation or palliative services that beneficiaries receive after, or in some cases instead of, a stay in an acute care hospital. Depending on the intensity of care the patient requires, treatment may include a stay in a facility, ongoing outpatient therapy, or care provided at home.
Post-acute care is often needed by workers who require assistance for a short time while they heal from an injury or a surgical procedure. This can include recovery from:
- Orthopedic injuries
- Surgeries such as joint replacement
- Serious chemical or thermal burns
Post-acute care is also used after an injured worker’s health has improved as much as possible and they still need help with daily activities because of their injury. Injured workers suffering from quadriplegia, paraplegia, or injuries of the central nervous system will often require post-acute care.
According to the Centers for Medicare & Medicaid Services Office of the Actuary’s
National Health Expenditures 2016 Highlights:2
- Home Health Care spending accounted for $92.4 billion or 3% of national health expenditures in 2016
- Nursing Care Facilities and Continuing Care Retirement Communities spending, at $162.7 billion, represented 5% of total health expenditures in 2016
What Types of Services Are Provided?
Injured workers can require a wide range of post-acute care services depending on a variety of factors. The nature of their injury, comorbidities, and pre-existing conditions can all affect the need for and extent of post-acute care. Post-acute care can provide for expert medical services such as skilled nursing and physical or respiratory therapy. Nurse’s aides may be needed to help with personal care such as bathing, mealtime assistance, and other daily living activities. If the worker is receiving care at home, general housekeeping (e.g., cleaning, laundry, and grocery shopping) may be part of the services provided. Along with skilled professionals, family members may participate in the care of the injured worker. In addition to the everyday care provided, injured workers may need to:
- Attend doctor visits
- Participate in fittings or repair of prosthetics
- Take periodic diagnostic tests
- Receive emergency care
Preparing for these trips and the associated transportation are also part of the post-acute care process.
Workers with permanent disabilities may need assistance with mentally adjusting to the changes in their bodies and/or adapting to different living environments. As such, psychological treatment may be part of post-acute care for these workers. Also, disfiguring injuries can challenge a worker’s self-image, so they may need help adjusting to their new reality. Physical limitations create difficulties that may cause discouragement and depression. Psychological care can help address these concerns and improve the worker’s quality of life.
Post-acute care allows medical staff to monitor a worker’s recovery, give advice, and answer questions, which can all be an important part of one’s recovery.
Where Is Care Provided?
For those cases requiring post-acute care, injured workers most often receive continuing care at home. Nursing homes and skilled nursing facilities are commonly used for the medical care of the elderly, but the needs of injured workers differ from the needs of most of the elderly population. Injured workers are often younger with an average age at injury of about 44.3 Furthermore many have dependent children and a spouse. Therefore, the incentive to remain at home can be very strong.
Although nursing homes are not as common for post-acute care as home-health services for injured workers today, the aging workforce may render their use more common in the future. The Bureau of Labor Statistics expects the number of workers aged 65 to 74 to grow by 4.5% from 2014 to 2024. The corresponding growth rate for workers 75 and over is even higher at 6.4%.4 In addition to the traditional nursing home, other forms of assisted living are becoming more common. In fact, the increasing variety of available care facilities may make out-of-the-home care a more attractive option. Nursing homes and similar facilities may be available to provide respite care for injured workers—allowing family members caring for an injured worker to take short breaks to temporarily focus on their own needs. For injured workers who are mobile but cannot take care of themselves, daytime care in a facility might allow family caregivers to keep working and/or take care of personal matters.
Will the Need for Post-Acute Care Grow?
Post-acute care is likely to become an increasingly important part of WC medical benefits as injured worker accident recovery times may lengthen due to, for example, the aging workforce or advances in emergency medicine and diagnostic techniques that may improve the survival rates for injured workers.
The nature of post-acute care will be shaped by medical advances. Medical science is discovering ways for disabled persons to increase their mobility using technology. Researchers are developing exoskeleton suits, improved wheelchairs, and electrical implants that may allow paralyzed workers—who may have otherwise been homebound—to stand, walk, and negotiate obstacles. As the most recent
Physical Activity Guidelines for Americans indicates, physical activity plays a role in many health outcomes including coronary heart disease, stroke, cancer at multiple sites, type 2 diabetes, obesity, hypertension, and osteoporosis.5 Post-acute care will encompass the fitting, maintenance, and training associated with these devices.
Stem cell therapies may enable greater recovery from central nervous system injuries with support for the healing process from post-acute care. Also, advanced treatments for severe burns may reduce the risk of infection, scarring of burned areas of the body, and the need for skin grafts, which may decrease the need for post-acute care. These patients may, however, need specialized post-acute care to aid in their recovery.
Post-acute care at home or in a facility will continue to play an important role in the lives of individuals who have suffered work-related injuries through a range of services including nurse’s aides, psychological treatment, and general housekeeping assistance. Healthcare advances may expand the scope of post-acute care to support advanced techniques. They may also result in an increased need for post-acute care due to improvements in the survival rates for near-fatally injured workers. As the WC landscape is ever-changing, post-acute care is one area to continue to watch.
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