reach personal injury services limited
Adult Cost Benefit Analysis
June 2006
1. Introduction
reach have reviewed all brain injured adult who have been referred for and completed a rehabilitation programme over the past 2 years. We note that approximately 70% of referrals for a reach rehabilitation assessment/report lead to a request for a reach home-based rehabilitation programme to be completed.
We have reviewed these rehabilitation programmes to establish qualitative outcomes from a reach home-based brain injury rehabilitation programme - outcome measures:
1. Care level pre/post rehabilitation
2. Employment status pre/post rehabilitation.
The number of clients analysed in this study was 29. (The term ‘clients’ refers to brain injured patients). In fact a further 4 clients started a rehabilitation programme but dropped out early due to circumstances outside reach’s control; however, they were assessed as having a good rehabilitation potential.
The age factor
It is important to remember that most Traumatic Brain Injury (TBI) adult rehabilitation clients are relatively young (under 40). The average age of the 29 reviewed below was 36 years, so that without effective rehabilitation, they would have been able to claim for several decades of considerable weekly care needs and of loss of earnings. (The life expectancy of TBI victims is similar to that of the general population).
2. Pre-accident
All clients were termed independent - either living independently or within a family unit - but functioning appropriately when in comparison to their peer group.
All clients were either in full time employment or in full time education.
3. Rehabilitation assessment/rehabilitation outcome
A. Care level
i. Pre-rehabilitation
The rehabilitation assessment highlighted that post accident, but
pre-rehabilitation, the clients required:
0 - 5 hours per day = 11
5 - 15 hours per day = 10
15 - 24 hours per day = 8
With an average of 9.3 hours of care per day, resulting in 65.1 hours of care
required per client per week.
It was established that the majority of clients received this support from family
members.
* N.B - 65.1 hours per week = 3385.3 hours per annum
@ £10 per hour for care/support - this equates to £33,853 per annum, per
client.
(This figure excludes case/care management and covers only average
annual care needs of a pre-rehabilitation head injury client referred to reach).
ii. Post rehabilitation – comparison
|
Care
|
Number of clients – pre rehabilitation
|
Number of clients – post rehabilitation
|
|
0 – 5 hours per day
|
11
|
21
|
|
5 – 15 hours per day
|
10
|
5
|
|
15 – 24 hours per day
|
8
|
3
|
0 – 5 hours per day = 21
5 – 15 hours per day = 5
15 – 24 hours per day = 3.
With an average of 4.8 hours of care need per day.
Therefore:
|
Hours
|
Pre-rehabilitation, but post injury
|
Post rehabilitation
|
|
Per day
|
9.3 per client
|
4.8 per client
|
|
Per week
|
65.1 per client
|
33.6 per client
|
|
Per year
|
3385.3 per client
|
1747.2 per client
|
Care costs:
|
Hours/cost
|
Pre-rehabilitation, but post injury
|
Post rehabilitation
|
|
@ £10 per hour
|
£33,853 per annum
|
£17,472 per annum
|
B. Work/occupation
Pre-rehabilitation, as identified at the rehabilitation assessment, the client’s
occupation during the course of the day pre/post rehabilitation was as follows:
|
Occupation
|
Pre-rehabilitation, but post injury
|
Post rehabilitation
|
|
1. Full-time (paid)
|
|
6
|
|
2. Part-time (paid) -18 hrs+hrs/wk
|
|
14
|
|
3. Full-time education/study
|
|
|
|
4. Part-time education/study
|
|
8
|
|
5. Not working/unemployed
|
29
|
1 – this person also required a great deal of care
|
The figures above indicate that pre-rehabilitation 100% of the clients were not
working or were currently on sick leave.
Post rehabilitation we found that 20.6% had returned to full-time work and
48.2% of the clients had returned to part-time renumerative employment with
the potential to increase their hours further.
28.5% had entered part-time study with the intention of securing part-time
employment once their area of study had been completed. (33% of these part
time study clients accessed, and were supported by, statutory services based at
college).
4. Conclusions
The number of brain injured clients within this study was relatively small (n=29) but significant to yield valid conclusions.
It has highlighted that following the completion of a reach home-based rehabilitation programme, these clients collectively achieved an average care reduction of 4.5 hours of care per client per day, thus a reduction in care need of 51%, with 68.8% of clients returning to/securing full or part-time renumerative employment.
We cannot, of course, guarantee that our estimates will be accepted at settlement, but we are confident that they will stand up to stringent independent scrutiny. When the costs of reach rehabilitation (about £50,000, including a full assessment and the most typical length of rehabilitation) are set against the typical award in cases of severe TBI (often well over £500,000 in the absence of rehabilitation) it is clear that rehabilitation saves an insurance company a very considerable sum.
State of play/evaluation – July 2006
Heather Batey