100% Stip Awarded issue now is level of care (California)

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100% Stip Awarded issue now is level of care (California)

Postby speropotus@yahoo.com on Tue Jun 23, 2009 2:34 pm

I recently settled a claim at 100% via Stip and Award. Injury resulted in quadriplegia.

Issue now is what level of care does my client need. Question was presented to AME who punted/deferred to the PTP.

Question presented to PTP, and he indicated by report that in order to assess need for 24 hour LVN care, he wanted a licensed medical professional to directly supervise the applicant for three consecutive eight hour shifts or 24 hours consecutively. After that period of observation, he wanted to see the results; thereafter, he would issue his opinions on what level of care was appropriate.

Are there any entities that provide such services. I am hesitant to go with someone "in-house," as I believe that such a provider for the carrier would be face with a conflict of interest. Could a nurse case management outfit provide such an evaluation?

Any suggestions would be appreciated.

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Re: 100% Stip Awarded issue now is level of care (California)

Postby stewshe on Wed Jun 24, 2009 4:44 am


To begin with, you need nurses trained in caring for persons with catastrophic injuries. The PTP should have some suggestions.

Care needed can vary tremendously, depending on the exact nature of the quadraplegia. Nurses assigned will have to be aware of your client's special needs.

For example, some will need a narrow temperature range since their own internal control may be out of whack. This is not a minor matter. In Fresno, e.g., it may add hundreds of dollars a month to a cooling/heating bill. Extensive ew AC/heating systems may be required, in addition to home modifications probably already performed.

Other patients may only need an attendant for feeding, hygene, and moving the client on a regular schedule to prevent bed sores. This combined with regular visits by a nurse and less often by a doctor to monitor the client's conditon.

I'd suggest a nurse capable of putting together a "lifecare plan." Again, something for the PTP to prescribe as it will cost a few thousand dollars.

The PTP's suggestion for a 24 hour observation peiod and report is a start.

I suggest you contact CAAA in your area for suggestions as to particular nurses who are able to do life care plans and to provide care for your client. Yes, family members can be trained and paid, but often the level of care is not as good and ends up being more expensive in the long run.
James T. Stewart (stewshe@comcast.net)
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Re: 100% Stip Awarded issue now is level of care (California)

Postby stevepsca on Wed Jun 24, 2009 4:52 am

If your client is SSA/SSDI/Medicare eligible, and/or a WCMSA is in place, you could contact that vendor for a life care plan. If it hasn't already been done.

The hospital discharge dept may have in home service evaluators/nurses to provide this service. At the very least, they may have a good referral for you.
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Re: 100% Stip Awarded issue now is level of care (California)

Postby postscript2 on Wed Jun 24, 2009 1:16 pm

What a tragic situation.

I would like to add, in addition to my condolences, that this I/W/client of yours is going to need more, much much more than physical care alone.

This individual is going to need social interaction with others... Be it in a group setting, support groups, field trips (and I don't mean the doctor's office), counseling, etc. I would also add that there is computer technology that's been around for years for those whom can't use their hands. The Dragon is outdated, but I'd also suggest some way for this I/W to be able to access the computer and be able to work and connect with the rest of the world.

Yikes, makes my problems seem like I only need a band-aide!

Again, sorry to hear about this but PLEASE consider what I have recommended as part of the treatment plan and life enhancement for this individual. On the old forum Art posted an amazing clip of such an individual whom created beautiful paintings with a paint brush in his mouth. I also read years ago, in fact I think I watch a video of a quad attorney who had voice activated computer equipment.

Keeping the I/W in bed all day long, and providing sustinence is not going to be enough here! Good luck and best wishes for finding the right "match" for a caretaker.

LCS :( :(
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