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Certificate program helps CMs find them
A 47-year-old man lost his leg due to a work-related accident at age 34. His remaining leg was shattered, leaving him with a full leg cast for nearly three years. His home was modified by a contractor for wheelchair access. The contractor hired by the workers’ compensation company to complete the home renovations underbid the job and had to return to the insurance company for more money.
Not only did the work not come in for the originally quoted cost, but the modifications were done improperly. The insurance company later had to ask a more qualified contractor to tear down the original work and reconstruct the home modifications. The insurance company paid twice for a single environmental modification project for a total cost of nearly $85,000.
"This is a familiar story," says Jim Karl, BS, GC, CEAC, owner of All In One, an environmental access contracting company in Woodstock, GA. "A typical contractor comes in and says, Yeah, I can widen that doorway.’ But he doesn’t understand the significance. He doesn’t know how the wheelchair works and turns on the floor. He’s focused on the doorway, but he’s clueless to all the issues. For example, he may have the door opening into the bathroom when there’s more floor space, and therefore more room to maneuver the wheelchair, if the door opens into the bedroom."
Karl has two workers’ compensation "redo" jobs. "We’re going back and tearing out the original work and doing it right at a cost of $20,000 to $50,000," he says. "What case managers and consumers should realize is that if an environmental access contractor bids the job originally, it may come in for about $3,500 to $5,000 more than a general contractor’s bid. Every item a qualified environmental access contractor suggests may add 5% to the total cost. However, if that’s what it takes to have the job done right, it’s still a lot less than $20,000 to $50,000 to have it redone later."
Two case managers’ frustration over the shortage of qualified and ethical contractors for their clients’ environmental access needs caused them to spend more than five years developing the certificate in environmental access contracting (CEAC) program. "It took us five years through study groups. It has been a slow, precise process, and now we’ve formed a board to take the steps necessary to move the certificate program to a true certification," says Kathleen Moreo, RNCm, BSN, BPSHA, CCM, CDMS, CEAC, owner of PRIME, a case management education and consulting company in Miramar, FL, and president of the Case Management Society of America in Little Rock, AR.
To qualify for the certificate program, contractors must have a minimum of two years of experience in environmental access work. "I told myself it was waste of time to go down and go through the certificate program. I had been doing medical remodeling for more than 15 years," notes Karl. "But what the program does is raise the professional standard of what we do and give the consumer confidence that they are hiring the right contractor for the job. The CEAC has guidelines, by-laws, and a code of ethics that contractors must follow. If you breach the code of ethics or fail to follow certain guidelines, the board will sanction you and take away your CEAC."
The certificate program is demanding. "I had already done this type of work for years, but I didn’t breeze through the 100-question exam with a score of 100. I learned a lot," he says. "Case managers who hire a CEAC contractor can read the report with confidence and be assured that when the job is done, no one will have to come back in." (See story, p. 115, for elements of a medical remodeling assessment.)
"The CEAC contractor is also someone who knows how work with a health care team," he adds. "Take a client on a respirator. I know I have to work with the respiratory therapist. The dust I’m creating during the remodeling process may be a major health impediment for the client. The client may have to move out for a period during the construction project."
Medical remodeling is a growth industry, adds Moreo. "It’s not just the disabled who need home modifications. The population is aging, and many clients want to age in place. Their homes are paid in full, and simple adaptations make it possible to stay safely in their homes as they age."
Of course, case managers know that many home modifications are not covered by insurance benefits. "It’s up to case managers to tell families that this option, home remodeling to allow disabled or elderly clients to stay in the home, is available. You simply must inform them that the resources are there and suggest they consider using them." Moreo says.
"Our responsibility as case managers is to address needs whether they are covered or not," agrees Anne Llewellyn, RNC, BPSHSA, CRRN, CCM, CEAC, owner of PRIME. "Let the family know that this is an issue they should be informed about. The case manager should also document that the client and the family were notified about remodeling options. That two environmental access specialists in the area were identified and recommendations made. This is simply what it means to be a holistic, turnkey case manager."
The CEAC program also offers case managers an opportunity to move into the rapidly growing medical remodeling market. "Medical remod eling was recently identified by a business publication as one of the 20 hottest career moves for working women. People want to age in place. We can’t warehouse the elderly any longer. There’s not enough room, and psychologically it’s much better for older clients to age in place than to be placed in nursing homes," says Moreo. "The need for environmental access is going to come to everyone at some time. It’s a health and wellness issue. Case managers who can evaluate medical remodeling needs and make recommendations have an added skill. They become valuable resources to meet a wider range of their clients’ needs."
(For additional information on finding a qualified accessibility contractor, see stories below and in Case Management Advisor, February 1999, p. 31.)