8. Support pathway facilitators and barriers In this section, we focus on factors that are fundamental to and key facilitators for the person’s progress along the support pathway, or which, if action is not taken, can create a barrier. We have used information from the research evidence, and knowledge from people with lived experience and health and rehabilitation professionals to identify the best approaches and actions. These factors should be considered by all those involved in the support pathway, including health and rehabilitation professionals (including rehabilitation physicians, medical practitioners, nurses and allied health professionals, prosthetists, and prosthetic technicians), service providers, funders of prosthetic devices and rehabilitation services (e.g. insurers), and insurance scheme regulators.
8.1 Integrating and coordinating services and supports Research evidence reinforces that a fundamental requirement for effectiveness of treatment, rehabilitation and health care is that services and supports are integrated and coordinated [27-31]. To support the integration and coordination of services and supports, responsibility for monitoring the person’s progress across all services and along the pathway should be assigned to a single person, before or early after the amputation.
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Integration and coordination of the services and supports for a person who is traumatically injured and under a personal injury insurance scheme may be facilitated by people in different roles. These are:
•
community-based case manager (external case manager or rehabilitation case manager) working at a private, public or not-for-profit health and social service organisation, funded by the person’s insurer
•
community living facilitator or rehabilitation case manager working at the social insurance agency (e.g. icare NSW, within schemes such as Workers Care, or Lifetime Care and Support)
•
case manager working at the worker’s insurance funding organisation (e.g. EML, GIO, Allianz)
•
claims advisor working at the compulsory motor vehicle third party (CTP) injury insurance funding organisation.
Refer to the glossary for definitions of these roles. People working in these roles may have different titles in other social insurance schemes. The guidance recommends that an external (or rehabilitation) case manager is engaged by the social insurance agency (funder or funder representative) as early as possible following injury, but certainly at the point of entry into the specific funding scheme.
Recommendations
Grade
Funders must ensure a case manager is engaged as early as possible following injury and certainly at the point of entry into the funding scheme (Lifetime Care, Workers Care, Workers Insurance, CTP Care or other social insurance agency) to support the person with setting their goals and navigating the system, and facilitate the coordination of their supports.
Consensus
In Workers Insurance and CTP Care, the case manager is external to the insurers. In Lifetime Care and Support, Workers Care, the case manager may be an employee.
LC0063_Guidance_on_the_support_pathway_v10
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The person’s general practitioner (GP) should receive discharge information, and should be involved and a part of the multidisciplinary team from the time of the injury.
Consensus
The case manager is responsible for facilitating the link to the GP if this has not already occurred.
© icareTM | Insurance and Care NSW 2021
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icare Guidance for people with a limb amputation 2021
