Today was Corey’s first team meeting. For those of you following Corey’s Story after we moved home, this meeting is held weekly. PT/OT/ST as well as the Cognitive & Behavioral therapists, nurses, doctors and our case manager discuss Corey’s progress towards the goals set for her based on her admissions assessment and the FIM (functional improvement measurement) scale regulated by Insurance. The case manager collects the information then reports the goals/progress to the Insurance Company. The data is compared not only to the FIM scale but the InterQual standards (these are proprietary; standards created by the individual Insurance Company; the outline for our coverage). The data is also compared to the national average of progress for patients in rehab for whatever cause the patient is admitted for; the data is either approved or denied.
We would need more than this carepage to discuss Insurance Companies and why this system is so fractured! This subject is the main reason I am now working with the Brain Injury Association and the PA Coalition for Brain Injury. We need to advocate for the patients, hospitals, sub-acute facilities and home health agencies that provide nursing and rehabilitation services. Patients require specific services to regain their lives. Their progress and recovery can not continue to be regulated and limited by the “for profit” Insurance Companies.
Tendon lengthening rehabilitation coverage is 2 weeks based on the national average. This is the same length of stay for an athlete or a TBI patient. Once again, we will fight for the Insurance Company to stop looking at Corey as a #CB1234 and look at an individual that could make tremendous progress if given the acute rehabilitation required for her OVERALL recovery…NOT just her heels!
We currently have May 29th as our discharge date. Corey must work very hard in the next two weeks to not only meet but exceed her goals for us to have cause to fight for another week. We are already preparing our arguments knowing that we will begin battle to defend our plea for the 3rd and hopefully 4th week when the casts come off. Once the casts come off, we must continue the acute level of therapy at home to prevent any regression.
The staff remembers Corey well. Seeing the progress she’s made in the last year she’s now quite a celebrity at Bryn Mawr! Everyone is amazed and the buzz is circulating throughout the hospital. They are committed to working with her and for her to maximize her stay and fight for whatever time we can get approved to advance her progress.
It was a long grueling day for her but she did very well. She was awake at 4am ready to start her day! Yes, 4am…Fortunately, the staff took my advice to build in long rest periods between the morning and afternoon sessions. Corey sleeps soundly during her 1.5 hr break. She is in a great deal of pain but this kid is tough! She continues to stand even when her legs give out. She takes a step even when she feels shooting pain and her little toes peaking through her casts’ show her foot is swelling. She keeps working and smiling through it all. The therapists are very careful to alternate exercises to allow Corey matte time not only to sit but elevate her legs. They push her but not to the point of total fatigue so she won’t participate in their sessions.
Today OT worked on balance and upper body control. Corey was twisting her torso to reach behind her as she moved a ball from her right hip, across her back to the left side, then twists to the left to retrieve the ball to begin again on the right. Sounds easy? There is in fact 18 muscles needed to complete this simple exercise. PT worked with Corey for 1.5 hrs in the afternoon. Her greatest accomplishment was walking 15 feet. It took 2 therapists and 2 breaks but she did it!
Tonight Corey and I were talking about her day. Thank goodness for short term memory loss…she didn’t remember the sessions or the pain! We did discuss each session highlighting the advances but reinforcing that we can’t give up. Never give up and never give in. The only direction we are going in is forward. At that Corey told me, “We can’t go backwards. We’d trip and fall on our face…that would be bad”. I laughed out loud and completely agreed!
Corey there is so many metaphors for moving forward. You literally are moving forward with baby steps. Every step is going to build strength, stamina and distance! Great accomplishments don’t happen all at once. They are achieved one step at a time. Achieving smaller individual goals are often required to build on one another before you will be capable of hitting the ultimate goal. Your daily achievements have been and will continue to build the foundation for your goal ~ full recovery. Nothing is impossible especially if you have patience and persistence. In our case, 1 out of 2 isn’t a bad place to start! Happy dreams, xoxo