A serious injury can affect almost every aspect of a person’s life and the lives of all those around them. Even if there are funds available, for instance as a consequence of a successful compensation claim, the sheer scale of the treatment, care and equipment needed can be overwhelming.
Therefore, in many serious injury cases we involve the services of a case manager, the cost of which is included in the claim itself. As a case manager can be involved in most aspects of that claimant’s life, it is important that the individual meets them first and feels that they can work with them.
We asked experienced case manager Jane Jackson, a specialist in helping those with brain injuries, to explain more about her vital role.
ALS: Can you explain your background and how you became a case manager?
JJ: I trained as an occupational therapist and, during my training, worked in a brain injury rehabilitation unit. I was ‘bitten by the bug’ as they say and after completing a basic grade rotation and working for a year as a Senior 2, I applied for a job at the same place where I had completed the placement. I then worked my way up to rehabilitation manager. During my work there I met with a few case managers and one of them asked me if I was interested in case management. I then worked for that organization part time then full time before making the transition to working for myself.
ALS: What would you say is the key role of a case manager?
JJ: As a case manager you provide initial and repeated assessments to formulate client centered plans which need to be monitored and re-evaluated. The plan can include getting the right treatment, organising care, helping with benefit applications and organising equipment evaluations. For example, if there is a need for paid care, then it can be daunting for the claimant and their family to know where to start in terms of arranging and paying for that care, even with the help of their solicitors. I can arrange interviews, help set up payrolls etc. and ensure the family are happy with the carers.
ALS: What would you say are the most important aspects of your role?
JJ: The most important aspect of my role is to act as an advocate for the individual. This requires a good understanding of the person and their situation and the nature of their injury –in particular, the impact that the injury has had on their lives and the lives of their family. Brain injury, for example, in general is poorly understood and people will make judgments and formulate opinions based on what is presented to them. For example, clients with problems with motivation and drive can be labelled as ‘lazy’. Clients with poor attention and memory can be labelled by others as ‘stupid’.
As a case manager you can ensure that the behaviour the person presents is understood by others and is related to the nature of their brain injury. Being the main point of communication and ensuring that information exchanged between parties is clear and accurate is important. Other roles can be many and varied; I have even changed a light bulb!!
ALS: In your experience, how does the impact of a serious injury affect the family in ways perhaps that may not be obvious?
JJ: This is of course dependent on the age at which the injury occurs, the nature of the injury and the individual’s place in the family. Traumatic brain injury is more prevalent in young men. If they are married with a family this can impact them in a variety of ways. Often returning to work is either not feasible or they may not be able to return to their previous employment. This of course affects finances but also the individual’s role as the breadwinner, father, husband etc.
Often spouses become carers. If parents are involved, they tend to be over paternalistic, which can cause friction and changes to the dynamics of the family relationship. All families are complex –that is life – but add in a brain injury, a clinical team, carers and a litigation team and it becomes a challenging situation which takes diplomacy and tact to manage. I often think training as a negotiator would be an asset.
ALS: How do you deal with the effects of the injury on other family members?
JJ: Each family member will have had a unique relationship with the brain injury survivor, and this may have been forever changed by the injury. Each individual will also have their own expectations about the role of the case manager, some more unrealistic than others.
Parents of children with birth related injuries have had a life-changing event and are often going through a grieving process themselves. At the same time, they are fighting to get their child all that they can to give them every opportunity to get the best support and therapy. They have often lost hope for the child that they should have had. Naturally, they have high expectations of the case manager and it takes time to build a relationship and build trust, which can mean that other priorities have to take a back seat and it may appear that things are not moving as fast as others would like.
ALS: Have you arranged some help or equipment that people reading this might think was unusual, and that really made a difference to an aspect of somebody’s life?
JJ: There is now so much information on the Internet and equipment and therapies that are recommended are ever changing. Some family members are particularly keen on researching new and innovative equipment and therapies. As a case manager, I always ensure I have an open mind.
One of my client’s parents found the Molliisuit, which has proved really effective. This was researched and developed in Sweden. This is a type of mild, low frequency electro-stimulation which prompts the body’s neurological reflexes such as reciprocal inhibition via the antagonist to relax spasticity and other motor disabilities in selected muscle groups. This has a carryover of up to 48 hours after a 60minute treatment after which Molliican be easily reused; it can be used at home or in a clinic. It is of particular use with children with cerebral palsy but can be used with stroke, spinal cord injury and acquired brain damage as well as other diagnoses involving motor disabilities. It is possible to hire the equipment too.
ALS: What do you enjoy and what frustrates you the most about being a case manager?
JJ: I have developed a thick skin over the years and there is little that really frustrates me –probably the travelling more than anything! I really enjoy the face to face work with the clients, problem solving, being involved in putting together rehabilitation plans and training the support team. I am very fortunate to have had many years working with experienced clinicians and learning from them, so I really do feel I can pass on this knowledge.
Working with families and friends surrounding the client is also an enjoyable part of the job. I feel it is vital to involve them where appropriate or possible, as they can be an integral part of the process of working with the client to help them achieve their goals. Over the years I have been able to develop a good understanding of brain injury. What is important to understand is that no two brain injuries are ever the same because no two people are the same. A quote by Symonds (1937) sums this up really well “it’s not only the kind of injury that matters it’s the kind of head.” That is what makes the job challenging and it is the challenge that I enjoy.
Interview With Jane Jackson – Case Manager