And hi, I'm Carrie, a stroke survivor, and a member of BIND as well. And today we'd like to welcome Tonja, who is a case. It was the case manager supervisor at Pate. She will be here to help us understand the role of case managers and the benefits to brain injury survivors and their families. So welcome, Tonja.
Oh, it's nice to be here.
Nice to finally meet you.
Nice to meet you guys too.
Welcome to BINDWAVES, the official podcast of the Brain Injury Network of Dallas. I'm Brian White, BIND's Executive Director. On each episode, we'll be providing insight into the brain injury community. We'll be talking to members and professionals regarding their stories and the important role of BIND's Clubhouse. We work as a team to inspire hope, community, and a sense of purpose to survivors, caregivers, and the public. Thank you for tuning into BINDWAVES. Let's get on with the show.
So just tell us a little bit about you before we get into all that. What is a case manger stuff? Just a little bit about Tonja.
Okay. Um, well, I started out in the work comp world. Um, I did field case management for 20 plus years. Um, working with workers' comp patients. Uh, came to Pate eight years ago. And, um, initially just as a case manager, moved into the supervisor role. Um, pretty early on. But have learned a lot about brain injury. Case management. It's a little different on the commercial side than it is on the work comp side. Um, but have been doing case management my entire career. So,
wow. Okay.
Yeah. I have already questions for your position. But, we've had a couple of, uh, guests that are actually from pate. And we have had listeners that probably understand what Pate is, but can you tell us a little about, what Pate is? Just so our listeners can understand it a little bit better just with the ongoing conversation.
Yeah. So Pate is a brain injury rehab clinic. Um, we have both inpatient and outpatient programs for survivors of stroke. Traumatic brain injury, anoxic injuries. Uh, we deal with brain tumors, anything that's a brain injury diagnosis. Um, we offer six hours of therapy a day. That's PT, OT, speech, cognitive therapy. We also have neuropsychologists. So we do counseling. Um, case management nursing, we try to be a comprehensive program, um, for anyone with a brain injury.
Okay. And think that's good. Um, so you said you've been doing case management basically your whole life. So what made you just go? I think I want to be a case manager because that's not like a career you really ever hear about growing up and
no, and it's not actually what I started out to be. So when I started college, I wanted to be a physical therapist and then I took chemistry. And did not do so great. I changed my major and went into rehabilitation studies at University of North Texas. Didn't really know what I was going to do with that. It was more geared towards the, at the time called the Dars program. The state program didn't really want to work for the state. Um, so I worked my way into the work comp world.
And did case management with that degree. Uh, ended up getting my master's degree in rehabilitation counseling. And, um, continued my case management career, um, until I moved to Pate.
Okay. So you're also at. Licensed registered counselor.
I'm a certified rehab counselor. Yeah. Not an LPC. CRC. Yes.
All kinds of crazy. And so hard for us to keep up with, but
yeah, lots of different credentials. Yes.
And they're like all the letters and it's just a lot. So thank you for like, understanding that for us.
Absolutely.
Yeah. Um, so I actually had a question actually about, uh, work comp and I guess like now, how did it go before between work comp and like your position now as a case manager? Like what do case managers do. You know,
so we're basically coordinators. Um, we're coordinating care for the patient. Um, we're coordinating. Discharge planning for the patient and the family or whatever loved ones we're working with. Um, we're coordinating communication between our therapy team and their outside medical providers, their insurance company. We're helping with insurance authorizations. We're helping them get other resources from the community, whether that be filing for disability or.
Getting powers of attorney set up, helping them get durable medical equipment. Um, getting them set up with DART paratransit, any kind of community resource you can think of. We're helping coordinate. For that patient, if it's appropriate. Yeah.
And I totally get that because actually that's how this question started a conversation between Carrie and I. Um, preparing for this episode, it's like we remember case managers don't really know what they did. But maybe our parents did. Maybe our family. Yeah.
So sometimes we're kind of behind the scenes. Cause you guys are in therapy. Um, and we don't, we try not to interrupt that process, but in the background we're working on. Hopefully helping you secure some income, keeping your insurance up to date and current keeping you authorized for treatment, and then helping you progress into whatever that discharge plan looks like and making sure you have what you need once you leave our program.
Okay. And that was one of the things that I had asked that Kezia were talking. I was like, I know my mom filed all my. SSI. No, I didn't, I didn't have the ability to, so the case manager does help with filing for disability.
Correct? So we have different resources that we can give families. There's companies out there that can help you file, but we've, I've also walked people through the process myself and help them fill out the questionnaires, make sure that we've got all the documents. You know, ready to go, um, and then help them walk through the process. So, and there's lots of resources out there. Not everybody qualifies for every resource.
We try to figure out, you know, what's gonna be best for that person and help the family access those if we can.
Okay.
Right. Actually have like a random little story. I don't know if I have told you Carrie. Um, So I was hospitalized in Chicago and my case manager in Chicago. She helped my dad figure out how I can get a purple helmet instead of a normal black.
I do remember that story.
Yeah. Like I that's like my dad remembers our case manager because she figured out how I can get a colored one. Yeah, it was wild.
Yeah. It can be something small like that, but if it. Brings joy and some, I mean, you're struggling with a lot at that time, but little things like that can make a big difference. Right.
Thank you so much for that. Um, well, now that's talking about all these like positive things. So I think that was a positive. But what is like your best part about having this position as a case manager?
I think it's just being able to help the families and the patients and let them realize they're not in it by themselves, that we are here to help. Um, a lot of times they're coming from the acute setting where the case management is a little different there. Um, their role is basically to find that next level of care. Um, but they're not always focused on. What is discharged, gonna look like what's what's real life gonna look like once they leave the rehab program.
And we get to kind of start guiding that process. Um, we may not be their last stop on the rehab. You know, timeline. But we're close to it because we're post-acute so we're trying to help them get their home set up. Have our team go out and do home evaluations, decide if they need ramps or grab bars, you know, what does that look like? What will insurance cover? What will insurance not cover? Try to help them plan for what that next step is going to look like. Right.
Okay. And I know one of the things we didn't talk about discharge. And when those things that we wondered about, so like what, how does a case manager help or what kind of recommendations can they give? If. The discharge is being planned, but maybe that person's not really quite ready for discharge, because I know in my situation, they were ready to discharge me, but both my parents were still working full time. And my parents were. We want her in the day neuro program here. Right?
Because we lived down the street and y'all can pick her up and take her home. We are not comfortable leaving her at home alone, eight hours a day. She's not ready to do that by herself. And so they now I'm assuming, that's probably the case manager figured out a way to extend my stay until there was an opening in the day neuro program. And then I could go home and spend my day still back at the facility.
Right. So insurance dictates a lot of that. Um, Unfortunately. We all have to have insurance. Yeah. Um, However our role is to advocate for the patient. So if we have a good medical necessity basis for keeping you. We're going to fight for that time. Every time we can, um, we let the insurance company know what those barriers are for you to go home. Sometimes they're social. Sometimes they're medical. Sometimes they're both. Um, insurance isn't so concerned with those social reasons.
Sure. But it does play a role in your safety. So we stress all of that to insurance. We do peer-to-peers we give them all the clinical information. And fight for that time. Um, if we get in a situation where there's just not an option, they're going to make us discharge you from the inpatient program that we can help families navigate. Do we need to look at. You know, for a short stay in a longterm care facility, some type of group home or.
You know, long-term care nursing home type situation where you could maybe still do the outpatient program from that location until you're safe to move home and then continue day neuro. So we, we help families figure out what's the best fit. Okay, so that we keep you safe. We have to have a safe discharge.
Okay. Yeah, that's good on, I thought,
yeah, I think that is really good. Yeah. With your explanation as to like, I think that was a really good explanation for sure. Um, right now, it's going to steal your question by the way. Um, I was wondering, and I had this thought in mind cause you coordinate between different, um, therapists and all of that. I saw this word from my stepfather. He said, it's a chaos coordinator. Do you think that's what it is?
Yes. Yeah, absolutely. Yes. We we call ourselves that on a regular basis. Yeah. It's because things are ever changing. So one day we might have authorization and everything's going along fine. And then a wrench gets thrown in the plan or. You know, they had a loved one that was willing to take them in. And then at the last minute things change and they're not able to, so we have to change gears and start looking for a different plan. It's constantly changing. Right.
Um, If I've learned anything for being at Pate it's constant change. And you just have to roll with it and start looking down another avenue or another path, um, to find what's appropriate for the patient. But yes, chaos coordinator is a very good description.
Yeah. I took over her question. As I was
it's, okay, I'm going to take a quick little break before I ask my next question and just remind our listeners. Don't forget to hit that like button, that subscribe button, and maybe go ahead and hit the notify button. And if you're watching on YouTube so that you get notified every time. A new episode is out, which is every Thursday. So now back to Tonja. Um, so speaking kind of, of that main chaos coordinator, what would you say is the most challenging part of being a case manager?
Just the chaos.
It's. It's the ever-changing process of getting people safe, discharged, but it's also, um, dealing with insurance is definitely a challenge, uh, on
I. Can only imagine
pretty much a daily basis. Um, we're. Always wondering, you know, if we get a denial, what, where do we go from here? Um, Beyond that. I mean, dealing with patients and families is the positive side of it. Most of the time. Uh, it's typically that administrative side that is the most challenging.
That absolutley makes sense.
Yeah. And I think that as a, you know, as a case manager, During our recovery time, like you get to miss the part where we get out of hospital. Right, right. And then you, but you made this like, Like part like halfway. I not even halfway. I don't know if that's a halfway or not, but this like step in the middle of becoming, going back to like more independent. More independence and that's so I can totally understand. Right. How difficult that is for sure.
Um, do you have, uh, like any situations that remind you of these positive moments and like rewarding moments, um, as being a case manager?
Definitely. I mean, I've got definite examples of patients that came in who were non-verbal and when they leave, they're able to speak. Um, and communicate, which is huge. Or patients that come in in a wheelchair and they've been told. Or their family's been told that they may never walk again. And by the time they leave our program, they're walking and taking steps. They may not be fully independent in that, but it's more than they anticipated reaching.
Um, we have lots of examples of just patients who come in at one level and by the time they leave us, Some of them go back to work. They go back to driving, they go back to their regular activities, um, which is really rewarding to see.
Now, I'm going to ask a really random question. I don't know why this just popped in my head and this has nothing to do with case management. But do you ever go out to the Anna location?
I do.
Do the patients get to pet the horses? Or do they have any interactionwith the horses?,
There's horses. Yeah.
There are, it's a beautiful facility.
Um, our Ana location is a ranch. And so we do have, um, I believe there's a donkey and two horses out there. I think the donkey might not be. I'm keen on being petted. Um, but yes, you can, um, interact with the, with the horses out there.
Just random.
Oh, that's cool.
It's a beautiful facility out in the country. It's an Anna.
So I've been out there to speak for y'all. That's why I know about. About the horses.
It's a totally different setting. Dallas or Fort worth.
You start driving out there and you're like, wait.
Where is it?.
Are you sure We're going to a rehab facility? The yes were in the country. we're on this little bitty, tiny road, and then you're like,
and then there it is.
I think that's really interesting too. Cause like I didn't do my rehabilitation. My inpatient. I was in Chicago, still on my right. So right now they hear like your experience and where you go to have conversations and like your position and pate. Um, I had, um, I was in Shirley Ryan. And I was like, I thought it was normal that everyone gets a dog. But now that I think about it, maybe the dog was my horse, you know, like.
Um, so, uh, every, every week I think multiple times a week, I think like twice I got a dog that I can like. Train, but I think it was also helping me be able to speak. And like take notes, like, okay, you have to remember the, get this little pet, like, you know, get this little tree and do it on the right. And like all that. I think it was both. It was therapy. Yeah, the therapeutic
probably from your right neglect too. to give the treat on the right side.
Yeah, the moment I start hearing more about like the positions, I'm like what your work is and how that affects, um, Brain injury survivors and the patients, the clients, right. And I'm like, oh, that's what they were doing to me. That's why I got a cute dog.
Everything has a purpose. But yeah, animal assisted therapy is awesome.
Yeah, that's pretty cool.
Sometimes have therapy dogs come in. to interact with patients, but. Yeah.
Okay. Tanya. So now the big question we ask everybody, how did you hear about BIND?
Um, I've known about BIND for years. Um, I actually came over. With Brian and some of the other therapists from Pate. Um,
so I've known you longer than I knew. I knew you
probably. Yes. I came over for one of the days when you guys were doing games. Um, and we played, it was a card game and I honestly can't remember the name of it, but it was a lot of fun. Uh, we brought some patients with us to introduce them to the program. Um, because we were recommending that they join. And I have patients that I recommend, um, to join bind when they leave our program.
That I just don't. We had our own back. So do you keep in touch with any of those patients? Do you know any that have come over here that? You could say benefited them.
I'm know I've seen pictures of some of those patients, um, that have participated and yes, they definitely enjoy their time at BIND.
Yeah, that's actually how I learned about BIND. Um, again from Chicago. I come to Texas. No, nobody other than my mother and my stepfather, that's all I knew. And then, um, my case manager and my counselor, or the ones that told me about BIND. And recommended that I come here. And I think it was more like the social. You know, You know, being able to be around people. Cause I didn't know anybody, I have issues right. With the aphasa and all of that stuff. So
it's like, a good social outlet. Yeah. And I love the working aspect of it as well.
That's kind of the selling point for BIND is. Again, our kind of tagline is, you know, to get integrated back into the community and what better way than to start with your own community. Where everybody gets you and you can get that comfortableness. And that. Okay. I'm not the only one in the world that has this issue. I'm right. I'm not crazy. And well, I'm crazy, but. Not that way. I'm not alone in this world. I mean,
it's nice to have peers. Similar and have similar experiences.
And it definitely. Again, we say it's not real therapy. It's therapy by doing, which has totally helps. our aphasia your friends because they get in this setting and they can, you know, Chit chat and work on that. And like, I was lucky enough to not have aphasia. But I get aphasia. I totally understand it. So I know how to be patient and. Ask the questions or ask, do you want me to ask you the questions or do you want me to just let you fight through it? Right.
Kind of what I've learned, but Tonja, I am so thankful that you came to join us today and tell us more about case management. As Kezia said, we both knew they were case managers in our lives. We just weren't. A hundred percent sure what they did. And I knew more than they helped my mom. And I saw, I don't know, but thank you so much for clearing that up. for us. For us and for our listeners and for new survivors.
And they know if you're still in the hospital and you need some help, ask for your case manager.
Absolutely. Thank you so much for inviting me. I had a great time.
Thank you.
Thank you. And obviously thanks to all our listeners who listen to us. Uh, but just make sure that you know how to connect to us and you can always email us for all the next episodes. If you have any questions for any of our guests bindwaves@thebind.org, follow us on Instagram, which again, guess what it says at. @bindwaves and visit us on our website. It's super cute. Don't miss. out on it. It's the the.bind.org/bindwaves.
Slash. Slash. And also don't forget. Click the like button, the share button. This. subscribe button. Just again, like I tell you every time, just click all the buttons, whatever, if there's a button, click it, it's going to do good things. So again, you can follow us on all your favorite platforms and you want to see our pretty faces. at least we think they're pretty on YouTube as well. So. Continue listening to bind waves.
Every Wednesday, you'll find us. Yeah. Oh, every Wednesday it's Every Thursday. Uh, you'll find this on your social platforms. So until next time
until next time.