Feb 082010

Last week, I met my case manager, about nine years late. It’s taken me since then to see if I can figure out what happened. Nope. It’s not that I’m new to case management and slow on the pickup, it’s that it was so, well, limp.

Back in mid-1991 I was in a rear-ender that resulted in a severe whiplash (OMG, the pain was unreal). About a year or two later, the insurance company changed adjusters and the new one assigned a case manager to me. That manager spoke to my doctors, got a complete file on me, and met me. What I remember about her most was what a whirlwind of activity she was. She figured out what I needed medically and work-wise and got to work getting that for me. She didn’t just sit at my kitchen table, she moved.

This one, the very nice 2010 one, sat at my kitchen table sort of looking at my file every so often while I struggled to figure out what she could do for me, given that I’d met the assessor three months ago. Like I’m supposed to remember what happened way back then! Hello, brain injury here.

Whereas the 1993 manager assessed me herself; this one did not. She had my entire file — my application to the ABI Network and the now out-of-date assessment from last year — but she didn’t seem to be well informed. Or maybe that’s her style, to be so ephemeral that I felt I was swimming in a white sea of vagueness.

Whereas it was obvious how it worked back in 1993 — the insurance company hired the manager, but I was the client — this time, I’m flummoxed.

To backtrack a bit: The insurance company was supposed to hire a case manager for me — I mean, who in their right mind doesn’t hire a case manager for a brain-injured claimant? My insurance company, that’s who. Case managers don’t just help the claimant, they also help the insurer save money. Anyway, as long as I was “covered” by insurance, the government wasn’t going to pay for any services for me, other than OHIP rehabilitation programs like outpatient neurorehab at the Toronto Rehabilitation Institute. So I was stuck, and according to the 2010 case manager, I wasn’t alone. She’s heard the same story many a time. I no longer feel so weird asking for case management nine years too late!

The government system though is perplexing. You send in one massive application to the ABI Network, hoping you’ve applied for the right things because GPs are usually clueless when it comes to brain injury care and not being familiar with the services out there, I wasn’t anymore clued in. I had received some advice from a psychologist, and I followed her instructions without knowing who COTA, CCAC, and CHIERS was on this massive application.

Well, CCAC stands for Community Care Access Centre and COTA stands for, well, I’ll have to look that up. Hang on a sec. Um, still don’t know, something to do with occupational therapy. (CHIERS I don’t know.) Anyway, COTA supplies case management; CCAC the therapists. Does that make sense to you? Me neither. It gets better. They only speak to each other if I get them together, that much I remember from the four assessments I had last year. Relying on me: yup, that should work well. But how can a case manager work properly unless they speak to all the therapists and doctors involved? They can’t.

Whereas the 1993 case manager had me supply her with the name of every health professional I was seeing, the 2010 manager asked for no names. Despite the privacy act seriously impeding good co-ordinated medical care, it is doable in this situation. After signing stacks and stacks of release forms for my lawyer in years past, it’s really no big deal for me to sign one or two to give her permission to talk to CCAC and the therapists they’ve sent me. I don’t know how she’s supposed to manage my case relying simply on my word, the word of an articulate but forgetful brain-injured person.

As our meeting flowed vaguely on, my fatigue grew, and I struggled more and more to figure out what she could do for me. When I mentioned that yes, I’d met with a social worker, but unfortunately said social worker was only allowed to supply me with links and not the kind of social work I was looking for, I got zip response. When I mentioned I needed actual physio, not exercise instruction, she had nothing to say. I floundered, being nonplussed by this non-response. Am I really expecting too much from these people who work with the brain injured all the time to know who can provide the kind of OHIP-covered counselling and physio services I need? Am I really expecting too much that she knows of funding sources for everyday necessary articles and transportation? Apparently so. Of all the things I mentioned, funding she’ll look into for me, but she doesn’t know the answers off the top of her head. Oh brother.

Anyway because I had a fit over the disrespectful, incompetent, computer illiterate OT CCAC had sent me, as of mid-January, I have a behavioural therapist who in only two appointments is already doing wonders with getting me functional, lifting me out of the chaos of constant distraction and a schedule that doesn’t work. She even, gasp, understands how to use a computer and what a handheld is. She got me to open up my laptop on Monday, to show her my calendar and to put in the changes we were discussing. She gets that people with brain injuries have no initiation and need to be told do this, do that to get them moving. She then got me to show her my e-mail inbox and immediately saw why it was overwhelming me and how to bring it under control. From the moment this therapist walked into my home, she was so familiar with me and my file that she was ready to work with me. No friggin’ discussions of my needs. Sure, she had questions, but they were the kind that got me to think, that showed she was directing the session, thinking about how best to help me, not me doing that. What a bloody relief.