rehabilitation - aspasaaspasa.co.za/wp-content/uploads/2019/02/...rehabilitation-19-oct-20… ·...
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Rehabilitation Mine Health and Safety Council Summit Presentation
19 Oct, 2018
Presented by Dr. Deodat Kritzinger GM: Medical
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Outline of presentation
What do we mean with rehabilitation?
Policy and legislative framework – Department of Labour
RMA practice
Closure
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Rehabilitation
'Rehabilitation' means measures, in the form of clinical, vocational and social services and
facilities, provided with a view to the reintegration of employees exposed to an occupational
injury or disease back into work and to enable them to attain and maintain maximum
independence, full physical, mental, social and vocational ability, and with full inclusion and
participation in all aspects of life;
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Objectives of rehabilitation
1. Social Security Schemes respect the paradigm-shift from only compensating claims and paying pensions to creating structures and processes towards pro-active rehabilitation programs.
2. Return-to-work (RTW) strategies attract disability management programs to the state, the enterprises, insurers and service providers by preventive measures close to the worksite.
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International practice
Social Accident Insurers are successful in return to work
because of:
• their focus on the remaining abilities of workers with
disabilities, not on their deficits
• using experts and financial incentives to assist
companies in managing a return to work structure
• attracting service providers, mainly physicians and
medical clinics, to intervene as early as appropriate
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Disability Management Professional
Persuade
employers
Networking
Legal
knowlegdeMedical aids
Evaluation
Assessment
Ethical
behaviour
Case
Management
Social
competence
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Overall objective aimed at RTW
Job retentionRehabilitation
Disability
Management
Return
to
work
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REHABILITATION POLICY & STRATEGY
Topic Rehabilitation Statement Policy/
Strategy
Rehabilitation
Objectives at
CF
1. To facilitate early return-to-work of rehabilitated employees.
2. To ensure interdisciplinary involvement in patient management.
3. To facilitate social reintegration for non-return to work employees.
4. To reduce the development of complications by identifying high risk
employees.
5. To facilitate timeous provision of benefits due to the employee.
6. To involve all relevant stakeholders at every stage of the
rehabilitation process.
Both
Rehab Policy
Framework
1. Promotion of functional independence for employees who suffered
occupational injuries/diseases through vocational training, skills
development and alternative employment.
2. Re-integration of rehabilitated employees back into the workplace
and/ or the community.
3. Relation of a Return-to-Work strategy to compensatory
mechanism.
Both
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REHABILITATION POLICY & STRATEGY
Topic Rehabilitation Statement
Purpose of Policy 1. To provide the collaborative framework for efficient and cost-conscious
rehabilitation management in the Fund. It includes the key elements of current
good practice in injury management and the key strategies and procedures
required to support sustainable return to work outcomes for work-injured or
diseased employees across the mandate of the Fund.
2. To outline key stakeholders within the Rehabilitation and Reintegration value
chain, as well as their respective rights, roles and responsibilities in assisting the
Fund to deliver on its mandate.
Purpose of the
Strategy
1. To provide employers, employees, rehabilitation professionals and other relevant
stakeholders with guidelines for implementing workplace rehabilitation to assist
employees affected by work-related injuries and/or illnesses to return to work.
2. To have a common understanding on the implementation of rehabilitation
programmes in the Compensation Fund; and
3. To promote and encourage best practices on rehabilitation and reintegration of
injured and diseased employees.
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REHABILITATION POLICY & STRATEGY
Topic Rehabilitation Statement
Rehabilitation
Approach
The Fund will ensure that Case Management is activated as and when a claim is notified and that all
stakeholders are actively involved at every stage of the treatment and rehabilitation process, on a
collaborative effort and shared responsibility basis.
Injury/ Occupational
Disease
Case Management
Injury/Disease Management
Medical Treatment
Medical Rehabilitation
Rehabilitation
Vocational Rehabilitation
Social Reintegration
Compensation Fund EmployersMedical Service
ProvidersTrade Unions Other Stakeholders
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REHABILITATION POLICY & STRATEGY
Topic Rehabilitation Statement
Rehabilitation
Logic Model
To promote rehabilitation, re-integration and return to work of the injured / diseased workers and contribute to various
schemes designed to decrease unemployment in accordance with the Compensation Fund’s Policy Framework for
Rehabilitation, Re-integration and Return-to-work of Injured and Diseased Employees and COIDA.
Sustainable Social Security
Managed HealthcareQuality
RehabilitationFunctional & Social
Independence% Rehabilitated &
Reintegrated
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CURRENT OPERATIONS OF THE DIRECTORATE
Topic Rehabilitation Statement
Rehabilitation
and
Reintegration
Pillars
To promote rehabilitation, re-integration and return to work of the injured / diseased workers and
contribute to various schemes designed to decrease unemployment in accordance with the Compensation
Fund’s Policy Framework for Rehabilitation, Re-integration and Return-to-work of Injured and Diseased
Employees and COIDA.
Medical Rehabilitation
Vocational Rehabilitation
Social Reintegration
Provision of Assistive Technology
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REHABILITATION POLICY & STRATEGY
Topic Rehabilitation Statement
Key
Implementation
Strategies
These implementation strategies are the keys to achieving successful rehabilitation and
return-to-work outcomes and require collaborative participation by key persons involved in
the rehabilitation process.
Early Notification and Reporting of Injuries
and Diseases
Early Intervention and Case Management
Workplace Assessment for
Vocational Rehabilitation and
Return-to-Work
Rehabilitation and Reintegration Pillars
Provision of Suitable Accommodation
Consultation Confidentiality
Accountability and Leadership
Financial Responsibility
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REHABILITATION POLICY & STRATEGY
Topic Rehabilitation Statement
Monitoring
and
Evaluation
Monitoring and evaluation refers to the systematic and continuous collection of
information to measure progress about programs and/or projects over time and to
determine their worth, merit and value. It is essential to have a monitoring plan aligned to
the objectives of rehabilitation and the Fund in general.
% of known hospitalised patients referred for case management
% of rehabilitated employees successfully returned to work
% of rehabilitated employees successfully reintegrated into communities
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REHABILITATION POLICY & STRATEGY
Topic Rehabilitation Statement
Compliance,
Penalties and
Incentives
Rewarding high performers, and ignoring or punishing low performers, correlates strongly to
greater overall corporate performance. However, achieving this goal requires advance research,
planning, performance tracking and evaluation to determine whether the incentive is ultimately
working as intended.
Compliance
• Recognition Awards
• Grading Systems for Compliance
Penalties
• Frequent Monitoring
• Downgrading
• Impose additional fine in terms of section 87(2)(a) of COID Act
Incentives
• Point System Redeemable during ROE Assessments
• Penalty Reduction
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RAND MUTUAL ASSURANCE SERVICES
Electronic notification and submission of claims and required documents through member
/ employer and service provider portal
Hospital utilisation management
Case management of serious and re-opened claims
Pharmacy Benefit management
Pensioner medical plan
RMA Care facility
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MANAGED HEALTH CARE MODEL
Managed care, rehabilitation and disability manager
Case management and hospital utilisation management
o Clinical and claims adjudicator
o Case managers
o Medical advisors
Team leader pensioner care, rehabilitation and care facility
Pension medical case auditors
Pension liaison officers claims adjudicator
o PMP program
o Scheduled reviews DRG groups
o Mobile clinics
Case Manager Care Facility
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RAND MUTUAL ASSURANCE PMP
Plan developed with aim to follow up and engage with pensioners in need of
ongoing medical care and health needs.
Services rendered through Pensioner medical case auditors who will interview
all new RMA pensioners and enrol to the program where indicated or
requested
Operate through satellite offices in Maseru, Mthatha and Xai-Xai as well as
presence at RMA branches
Pensioner or claimant access through PMCA or RMA contact centre
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RAND MUTUAL ASSURANCE PMP
Year Home Visit Prosthetic Review Urological Review Grand Total
2006 331 684 217 1,232
2007 348 533 275 1,156
2008 257 461 317 1,035
2009 214 596 261 1,071
2010 175 600 282 1,057
2011 103 539 240 882
2012 94 593 304 991
2013 112 561 271 944
2014 77 444 274 795
2015 80 660 320 1,060
2016 103 564 352 1,019
2017 107 660 338 1,105
2018 115 497 382 994
Grand Total 2,116 7,407 3,833 13,356
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Prosthetic and mobile visits
Total number of clinics and visits performed by RMA staff and prosthetic partners
since start of PMP in 2006 is 264.
Annual schedule
• Botswana mobile clinic
• KZN – Ulundi, Ngoma and Mkuzi mobile visit
• Lesotho 2 mobile visits with 9 monthly assessment and minor repair visits
• Malawi mobile visit – Lilongwe and Blantyre
• Mozambique mobile visit – Xai- Xai)
• Swaziland – mobile visit in Mbabane and Manzini
• Eastern Cape – 2 mobile visits with 8 monthly assessment and minor repair visits
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Malawi visits and community projects
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OVERVIEW OF CARE FACILITY
OBJECTIVES
Physical well-being of the injured or pensioner; also mental
and social aspects = holistic approach
Pro-active follow up and intervention of preventable
complications: scheduled medical reviews – PMP
Skills development and training - alternative employment
and self sustainability; ultimate goal = reintegration back
into society
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OBJECTIVES
Basic principles of own health care and early reporting to limit preventable complications and repeated hospital admissions
Training and refresher training of care giver
Family support for visiting spouses
Enhance self–esteem, dignity, motivation, confidence and career life skills needed for reintegration, optimal function and independence
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CARE FACILITY
SERVICES
Specialised wound care
Skills development and training
Rehabilitative facilities with workshop
Prosthetic manufacturing
Gardening
Frail care
PARTNERSHIPS
CFM
APD
Prosthetic JV
MAKO Institute
RTW
Sedibeng
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SKILLS DEVELOPMENT AND REHAB
1. Skills development – formal program started February 2018
• Agreement Mako Institute
• Programs
• Sewing
• Shoe repair and leather works
2. Rehabilitation – formal program started December 2017
• RTW
• Individual assessment and recommendation
• Group sessions
• Life skill sessions
• Recreational and sport session
3. IT program and training – Sedibeng
• Trained 60 learners
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Gym Activities
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Occupati aonal DiseasesRMA PROMISE AND COMMITTMENT
Caring, Compassionate Compensation
12
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