Work Hardening is an interdisciplinary, individualized, job specific program of activity with the goal of return to work. The program usually takes three to four hours a day 3 to 5 days a week and lasts up to four weeks. Work Hardening is a program which utilizes real and/or simulated work tasks to strenghthen an individual for return to their specific job. The program itself is geared toward specific job tasks associated with the job using the Job Analysis that has been made available to us or we can do a Job Analysis for the job.
Components of a Work Hardening program
1. Development of strength and endurance of the individual in relation to the return to work goal. Equipment and methods that quantify and measure strength and conditioning levels must be utilized; i.e., ergometers, dynamometers, treadmills, measured walking tolerances; commercial strength and exercise devices, free weights, circuit training. Goals for each worker are dependent on the demands of their respective jobs.
2. Simulation of the critical work demands, the tasks and the environment of the job the worker will return to. Job simulation tasks that provide for progression in frequency, load and duration are essential. They must be related to the work goal and include a variety of work stations that offer opportunities to practice work related positions and motions, i.e., clerical, plumbing, electrical.
3. Education that stresses body mechanics, work pacing, safety and injury prevention and that promotes worker responsibility and self-management. The education component requires direct therapist/worker interaction. Video or slide presentations may be an integral part of the program but can not be the only element. These programs should cover physio-anatomy, back care, posture, pain management as related to body mechanics and safety. The role of exercise and the worker's responsibility in self-treatment must be covered.
4. Assessment of the need for job modifications. If the worker can return to the stated job goal but only with changes, i.e., added equipment, changes in work position or ergonomics changes at the work site, these are to be documented and reported tot he claims manager/VRC. Adaptations should be made and practiced to insure success. Resources for equipment should be researched and documented. On site job modification consultations must be pre-authorized by the claims manager and documented by separate report.
5. An individualized written plan that identifies observable and measurable goals, themethodology to use to reach these goals, the projected time necessary to accomplish the goal and the expected outcomes. This plan must be signed by both the provider and the worker. This plan needs to be based on functional capacity (base-line) evaluation and must be completed within the first 2-3 days of the program and these compared to the critical demands as stated on the job analysis. A comparative analysis (re-evaluation) is done prior to discharge to determine job readiness. These evaluations are considered part of the Work Hardening format and are not billed separately.
6. A safe work environment and atmosphere that is appropriate to the vocational goal and the worker. A designated work hardening area separate from treatment of clients treated for acute or clearly medical problems is needed. Amounts of space will depend on the number of workers anticipated, but at least 100 square feet per client is needed.
7. A written quality assurance system that provides for internal review of the program. Methods that record outcomes based on the provider's program goals and worker goals are essential. This is a separate evaluation from the L&I data sheet which is to be completed by the provider on each worker.
8. A reporting system that includes:
a. Documentation of the initial plan. (See #5 Components)
b. A meeting with the worker and the essential team members after the first five working days of the program. A report should be generated from this meeting and sent to the claims manager and the attending physician. This must include documentation of progress or lack of progress and future goals.
c. A discharge summary, with completion of the Department of Labor and Industries Work Hardening Data Outcome Sheet, that includes an assessment of the functional capacity level and the achievement of the individual's program goals. This is to be mailed to the Work Hardening consultant no later than 7 working days post discharge. The report only is to be distributed to the claims manager, attending physician and/or referral source.
d. A record of the worker's daily attendance including number of days and number of hours per day on the program.
9. Evaluation and modification of work behaviors. Work behavior that includes timeliness, attendance, ability to follow directions, interpersonal relationships, etc., are to be documented by established format.