We All Need a Little Help Sometimes

Think about a brain injury as a family event. Both the survivor and their family need resources and support to find their new normal. Our guest, Karol Falci, a neuro case manager for Baylor Scott and White in Frisco, is a brain injury survivor herself. Her background began in acute short-term care but is currently part of the day neuro team. She explains the difference between a case manager and a social worker. Karol’s greatest need is more resources - there often aren't enough for her to do her job. She urges patients to be persistent in recovery and their families to relentlessly help them find means of doing so. Karol also shares a few inspirational success stories and encourages brain injury survivors to keep going to find our new normal.

Transcript

0:02

Instrumental music playing

Carrie: 0:10

Hi, I'm Carrie, a stroke survivor and a member of BIND.

Kezia: 0:14

And I'm Kezia stroke survivor and member of BIND as well. And today, on this Thursday, we actually have our new guest, which we're excited to welcome, uh, named Karol Falci, who is a medical, medical, uh, social worker and case manager at Day Neuro in Frisco for Baylor Scott and White. Um, and today she's gonna be here talking to us about and continue the conversation about our day-to-day life and the resources we have. So. Welcome to the podcast, Karol.

Karol: 0:45

Thank you so much. Thank you for having me.

Brian: 0:47

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. BINDWAVES Let's get on with the show.

Kezia: 1:20

We're glad you're here. So, uh, we normally just start the conversation so that our guests tell us a little bit about yourself, so that we get to meet you, and then also our listeners. So, can you tell us a little bit about yourself?

Karol: 1:32

Yes, absolutely. Um, I've lived in Texas for 28 years. Um, I was born and raised in the Northeast, but I've been in the, uh, Case management, social work field for over 20 years. I have two daughters, one grandson. Um, not sure if you wanted personal or professional information.

Carrie: 1:59

Whatever you want to share.

Karol: 2:00

But I have worked in different venues. I've worked with special needs kiddos. I've worked with mentally ill population. And then most of my case management, social work has been in the medical field. And most recently the last five years doing brain injury. That's pretty much about me.

Carrie: 2:19

Oh, that's great. Again, we're glad you're here. We're glad to have you. Um, I think one of the first questions it is, because, like, I, I know these terms. Well, one I know, social worker, because my dad is a retired social worker. So I've known kind of what a social worker was my whole life. But he always worked in more mental health, so he couldn't share stuff. So I never thought to ask, what is a social worker? You know, but that's. And then when you get into the. medical side, you know, as a survivor, we hear this term case manager. So I think the first question for me, for our listeners, for our members, what is the difference, is there a difference between social worker or case manager?

Karol: 2:58

That's a great question, and being a social worker slash case manager, um, it is very confusing because, um, Back when, I guess, I first got my degree, everybody was just a social worker. And that entailed more like what you're talking about, more socio economic or mental health, behavioral health type things. Over the years, it's definitely changed. They have, um, especially in the, um, medical setting, A lot of RNs became what they called case managers. So we overlapped quite a bit. Like when I worked in the hospital, um, we had a team consisting of case managers and social workers. So the social worker side of it that I handled was more of the um, helping people get resources in the community, helping families that are in crisis. The, um, case manager side of it was more medical, helping hook them up with, you know, more medically, um, complex needs, as well as understanding more about the insurance. That has definitely morphed a little bit into combining those roles. So, like, the role that I'm currently in, I'm called the case manager, but I always put slash social worker because I feel like that's where my heart is at but So I do have to know a lot more about the insurance side of it so that I can help my teams with you know just ongoing therapies things like that families have questions now, you know years ago We didn't really think about insurance as a patient. You just got what you needed, but it's definitely changed over the years. So I know that's a long answer, but it's become a lot more almost the same title, it's just that there are RNs and there are people like myself that are just social workers, but most places call us case managers or sometimes care coordinators.

Kezia: 4:45

Okay. I can see, like, how the difference can be in, um, well you had just also told us that you've been at Baylor Scott White for five years, um, doing the case manager slash social worker. Um, I think that also plays a role. Um, what we think about acute, um, like when we're in the hospital and how different that is compared to day and year old, but can you explain that as well? Like what the differences are for case managers and social workers to be working in those settings?

Karol: 5:15

Sure. Absolutely. So when we say acute care setting, we're looking at a more short term stay. Like you think of someone comes in maybe through the emergency room, they need surgery or they get diagnosed with something life changing. So they get their direct care right then, you know, in the hospital, whether it be medication, surgeries, things like that. It's usually a short stay. And then they go on to either like some type of rehab, whether it be physical rehab, um, or like our program, like a day neuro program, which is much more long term. Um, so the acute care setting is definitely more of the immediate, quick, what are we facing right now needs. Where as, the daycare, I'm sorry, the day neurosetting is more of the longer term, um, needs and things like that. Our patients, the average short stay is about 12 weeks and we have some that stay up to 6 months or more.

Carrie: 6:12

Well, so I guess then the next question is, so you mentioned a little bit about insurance and then just other needs. So, what are, let's just, I guess the easy way to do it to answer the question, or ask the question is like, on a day to day, what do you as a case manager slash social worker do for the people in day neuro?

Karol: 6:33

That definitely varies.

Carrie: 6:35

Of course, every brain injury varies. So, we know it's not set for one person. We understand that.

Karol: 6:41

The boring side of it is I do a lot of paperwork. Um, I do a lot of care planning, things like that. Make sure all the documents are where they're supposed to be so that when we meet as teams, you know, we can plug in information. The more, what I call, fun side of it is um, everything from coordinating, like, care in the community, like, maybe a patient is discharged and they need to see a neurologist, that's a very common thing, and it might take three months to see a neurologist, so I'm going to be working on their behalf, you know, to try and get them in somewhere quicker, um, I also maybe will have to understand their insurance a little bit, you know, to kind of guide them to that, so it's everything from that, which can seem mundane, but when you're overwhelmed and you're trying to get lots of appointments in the families, you know, and um, in a pretty overwhelmed state and they've gone through a lot the last few months usually. Um, just anything like that is helpful to them. Something from that to, um, maybe they're having trouble getting food, you know, they can't afford some of the basic necessities. Having resources that they can go to, writing letters, so it's a lot of patient advocacy and kind of connecting and that's the side I enjoy more, but unfortunately because of insurance and things like that and regulations. I do have that big side of, you know, lots of paperwork, which also helps the patient, but it's not as direct.

Kezia: 8:03

Yeah, and right now that you're mentioning that it's not as direct, um, I like how you've mentioned sharing the resources and stuff, because maybe at that point we're not at that point. Yeah, to be an advocate for ourselves or know when we need resources. So I started picturing, like, how the possibilities are doing this for caregivers. Um, is this what you offer to them, like, as family members, friends, or caregivers? Um, yeah, so, like, is there anything else?

Karol: 8:33

Absolutely. Yes, absolutely. And that's another thing I love about our program. We do. And that is a huge difference between acute care, too. Usually acute care, you're focusing on the patient, probably 90%. By the time they come to us, I tell families it's a family event. Somebody in the family had an event, and it has changed their life, and it has affected everybody that touches their life. You know, friends, family, co workers, whatever it might be. But absolutely, a lot of times the patient doesn't even know what they need, and then family's not too far behind in the sense of they're just trying to get some normalcy, and they haven't had any for so long, so they're not quite sure. Um, they're dealing with emotions, fears, just, you know, lots of things coming at them, and also, you know, maybe paperwork that is just, you know, daunting. Yeah. So, it could be something as simple as sitting down with a patient and calling an employer, um, and, you know, working through some of the questions that they need to ask. And then same thing with family members. You know, like I said, a lot of times family members have been through a lot by the time they reach us.

Carrie: 9:42

Okay, sure. That's great. I'm going to take one quick little break and remind our listeners to go ahead and click that like button, click that share button, and click that notify button if you're on YouTube. Like I always say, click the buttons. Um, but thanks Carol. Sorry for the interruption. But, um, I like what you're saying because we talk about that a lot. Um, people think, oh, you had a brain injury. Well, too bad for you. People don't realize that. It's the entire family has had the brain injury. It's not just the survivor. We all have to, they all have to go through. There's so much that's not just patient advocacy but caregiver advocacy and we've been talking a lot about that this season. So I'm glad to get that out there because more people need to know. Yeah. They're not alone. But I guess kind of back on you and being a social worker, um, when you started you said you were in lots of different fields. What got you interested in getting involved with the brain injury community?

Karol: 10:34

It was kind of by accident. Um, I found a passion. Um, I loved working in acute care, but after a while, you know, you just feel like I need a change. So, I saw an opening at, um, Baylor Rehab in Frisco, and it was in the inpatient side. So I interviewed, and during the interview they talked about this day neuro program that was a little bit newer and up and coming and would I be interested in, you know, learning both roles? And I was like, sure, and I knew nothing about the brain injured population at that point. Started to kind of research it, and as luck would have it, the person that was heading that program, the social worker, went out on maternity leave only maybe a month into my coming on board. So I took over, and I never left. That was almost six years ago, five and a half years ago. So I just, um, I really found a passion there, um, and I just started to educate myself more and I love how I have a longer interaction with patients and get to see, you know, much more of their journey and be with them on their journey.

Kezia: 11:36

I love that. I actually, I was trying to figure out if I have met you before, but right now they said you were five and a half years. Years ago, I went to Baylor Frisco for like a very short time, and I was like, I wonder if I had met you, but maybe, you never know, you never know. But I like that. I like that you didn't know too much about, um, brain community and brain injury survivors, and I like that you were able to see the process, because we are not the same person when we first started rehabilitation until the end of the six months, a year, or a year and a half, like me. I was there for a while. Um, so I love that. Um, but did you experience anything unique that you may not have experienced in the other, um, like in the other experience you had as a social worker?

Karol: 12:31

I'm not sure. I guess the most unique thing would be just watching the process. Seeing sometimes somebody come in. Because I meet all the new admits that are on my teams. We have two social workers now. Sometimes the person sitting in the room with me is barely speaking, and I think just watching them, you know, throughout the process, that to me is the most rewarding and the most unique. I've never been able to do that. Like, I would work with patients in the acute care setting, and off they would go, and I would wonder about them, I would think about them, I would, you know, but never really ever knew any, you know, anything. And then to see them. You know, we do a little clap out and they wear a little lei at the end. Yeah, and we have a little certificate that people sign or we do words of encouragement. And sometimes it just, I mean, there's usually lots of tears because just seeing the difference, you know, in the person from maybe when they sat, you know, in front of me to when they're walking out that door. It's, um, that's probably the most unique thing that I've found in this setting.

Carrie: 13:35

Yeah, I can totally relate to that. I mean, that's one of the fun things about being here at BIND, is we stay connected with all the therapists. I mean, like, the lady that founded BIND was a speech therapist at the day neuro program I was in, and now our program director was, she wasn't in the day neuro, but she was a therapist at the inpatient side of the hospital I was in. So, I mean, I see all my therapists now, so it's fun. I call them, I'm like, Can I have you on the podcast? Can you do this for me? I need help. So. It's kind of fun because I know that's got to be hard as a therapist, as a case manager to go, I wonder whatever happened to that patient, and never get to know again. Now we talked about what's unique, so now we're gonna throw you the curveball. What makes being a social worker case manager to the brain injury community so challenging?

Karol: 14:23

Oh boy, that's an easy answer though actually. Oh, again? Yeah, because in the state of Texas, it's resources. Um, We, we have a great need for more resources for the brain injured population. We, we really do. Um, when I first started out in this role, I would be researching something, and I would be like, Oh my gosh, there's this program, or there's that program, and I'd get super excited, and then the more I would go down that little, I would find out, oh, this is in like, you know, Utah or Minnesota or something, not in Texas. So, um, I would definitely say the biggest challenge is resources. Um, we just have, that's why I love BIND. Um, we talk about you guys all the time, we, you know, we send people if we can because people still have so much to give and to give back and their, you know, it's, it's great. They maybe can't go back to the original roles they had before, but that doesn't mean they're done with life, and there's just not enough resources in this state. We just don't seem to recognize that population in the way that we should.

Kezia: 15:27

Yeah, I, I love that you're promoting us. But also, I think it's like an easy way to see like the positive and the negative at the same time, right? Like, There is a lack of resources in Texas, and I believe all over the United States, right? Like, there's just a difficulty, but at the same time, there's really great programs that can help people in the way that they need it, right? Um, I actually see it very difficult to be in a rehabilitation where, like, you're not saying that they're ready, right? It's like the insurance that's saying that that's about it, you know, so it is difficult for sure to let someone go and you know that you could probably do more. Um, I see that. But then you have programs so that they could do the next step. Um, but do you have like any like really successful story that you would like to share to our listeners? Because sometimes I think that that's the stories that they need, right? Like what, what happened that makes me feel like motivational or like something that I can do that I'm not the only one.

Karol: 16:31

Um, I think the one that comes to mind is a younger gentleman, obviously for HIPAA we can't, but we had a younger gentleman that had, um, has, continues to have pretty severe aphasia, was very young and just really wanted to get back to some of the basics of life, you know, driving, being able to go through a drive thru and order food, I mean just what we would think of as simple when we haven't had, you know, a brain injury. And just being able to work again in some capacity and, um, that really, I think the family did not ever expect that. Their expectations were very, very low. Um, of course, we always say we're just going to, you know, do as much as we can. We keep plugging through, keep plugging through. He was very fortunate in what you're talking about in that, um, his insurance was very generous. And he went through our program for a very long time and then went through our aphasia program we have. And, um, one of the, and it was just recent, and it's been over a year, probably a year and maybe four months, but he was driving. He shared with some of the other newer patients, which I know to this day. I would very much encourage them because there were people that were like, I just didn't even think I could drive, you know, and it's like, I look at him and I know I can. So he went back to driving. He practiced and learned, um, some of his favorite, uh, fast foods and other places to be able to order food. Um, he started working a little bit again, you know, it won't be in the same capacity, but he definitely was using like a voice, uh, not a voice, a texting program that was I guess it was about a week before his discharge, which, like I said, it was probably 18 months. Um, he said his first, like, full sentence, and one of our counselors was like, I was, you know, I was cheerful, and it was just, it was beautiful. It was incredible. And I think that gave a lot of the other patients in the aphasia program just, um, a lot of hope, you know, as well as. All of our patients when he shared about driving, you know, what he could share about driving.

Kezia: 18:43

Yeah. I love that you shared that story. I love it because that's kind of what we're trying to um, this year to really talk about and like let our listeners understand that maybe we didn't have a huge change in our lives, but these changes in our day to day life, Make a huge impact on us. Yes, like even if he couldn't like have full conversations. He was able to get his freedom back and like his independence and like these may not seem like as a huge success but to us like in and on both sides right like as a Social worker and like as a therapist that do this work. It's a huge success for you guys Yeah, that's amazing

Karol: 19:30

We talk a lot about a new normal and yes, you know, it doesn't have to be the same but it still can be normal for you, and it still can be fulfilling and enjoyable, and, you know, I think the key is just not giving up. And that's what I tell my patients the most, is just keep doing, keep trying, keep plugging, you know, don't, you know, I think I shared with you earlier that I had a stroke, and I got to be on the other side of that, so, um, I get what that feels like to be done with the program and think, Oh, well, this is it. And I could see where you could tell yourself that. And then you start to do more and do more and you just need to keep moving forward.

Carrie: 20:11

Absolutely. And that's what we try to share with all our listeners is that, yeah, the little steps are. They may be little, but they're huge to us. You know, just those little steps because yeah, getting back to driving for me was a huge one. Um, but kind of speaking about that, like once they discharge and this is where I don't want to misspeak, so I may be wrong, but one of our guest I'm not going to name names, so I don't say her name. I said something, she said something wrong. But, she mentioned, because again, we're trying to talk about things for our everyday life, but maybe there's some things that you didn't know you needed or need help with after you've discharged and now you're at home. And we were talking actually about driving, and she mentioned something about there was like a social worker assigned to each county that you could reach out to and get help from. Is there something like that that we don't know about that we even here at BIND could add as a resource to our stuff because I mean that would be awesome if it is because a lot of times, yeah, you don't know what you need till you need it. And that may not happen during, even something as extensive as day neuro.

Karol: 21:16

I'm not aware of that or a program like that. The only thing I could think of is the The work program. If somebody is signed up with that, they will have a case manager that follows them even after discharge. And that goes by county and cities and things like that. So they may be working on that.

Carrie: 21:32

You're talking about the Texas Workforce Commission? Okay, yeah. Like maybe the

Karol: 21:35

Texas Workforce Commission. But I, I always tell my patients and, you know, they could probably always just reach back to if they were in a program and ask. Um, I love to share resources. I'm always happy to do that, you know, with my folks. But, but you're right. Um, I don't know that there's anybody specifically that they could, you know, tap into. But, um, the BIND, um, The Brain Injury Network, maybe, that's a, you guys probably know about that as well.

Carrie: 22:01

Yeah, a program I should give to ONA to have them start researching.

Karol: 22:05

The Brain Injury Network? Yeah. Yeah, they have a lot, they seem to have a lot of resources. It does, it is, it can be time consuming, you know, to kind of follow down those, um, rabbit trails, but yeah, I know they do have lots of resources there, so. But I do have patients who will call back, sometimes months later. And I'm happy to hook them up with, you know, whatever I know, so.

Kezia: 22:26

Yeah, I love that. Um, I know very briefly, and I do want to thank you for sharing. That you two had a stroke. Um, I mean, it's a table. Stroke, stroke, stroke. Yeah. I couldn't even say that word. Yeah, I couldn't even say that. Like, all women, like, stroke survivors. I think that's very powerful. Yeah. Um, and I think, obviously, Carrie and I didn't know until you walked into the studio. Um, we were here, like, talking about your career, but your experience as well. It's, I mean, That's amazing. As a stroke survivor and also with your experience working, um, as a social worker and care manager, um, do you have any tips to our listeners? A lot of them are stroke survivors or caregivers that experience this, or ideally, same with, uh, um, medical resources that are also listening to us to learn about us. Um, do you, would you like to share any tips, uh, or like any motivational words for them?

Karol: 23:28

I think, just relaying back to what I said earlier, as far as survivors, is don't put yourself in a box. Don't tell yourself, oh, I don't think I can do that, or I can't do that anymore, or I can't do you know, just always say, I'm going to try. It might look different. You know, I, um I went snorkeling with friends and I can't swim since my stroke. I just don't have that coordination any longer. And I remember I was on the boat and I said, Oh, I can't snorkel. And my friend's like, What do you mean you can't snorkel? I'm like, Well, I can't swim. And, you know, it'll just be weird. And, you know, and she was like, No, no, no. And like one person took one side and then I was able to get the other going. And I mean, I snorkeled for like, you know, two hours. I had a blast. And I thought, Wow. That was my first inkling, like, stop putting yourself in a box and telling yourself that there's things you can't do, you know, figure out ways around it. So, that would be my, I think, the thing that I would say to, to survivors. I mean, I didn't, they told me that I'm, you know, Might not work again, you know, um, I, I was just very fortunate, but, um, and I know not everybody has the outcome I have, but I think that's part of it, is I think your rehab happens between your ears a lot. Um, so don't limit yourself, and as far as, um, family, or I guess maybe loved ones, or just ask questions, don't assume. Um, I had people assume a lot of things about what I was thinking, or how I was feeling, or what I needed or didn't need. I think it would have gone a long way if people had just asked more questions and not been afraid to do that. Um, and as far as, I guess, maybe other professionals, um, I think we just need to have more empathy, to really realize it's like, What I told somebody, it's like going to sleep at one age and waking up at another. That's how I felt, you know, if all of a sudden my body was not my body and, um, I equate it to aging. You know, as we age we're going to change, things are going to get, you know. So, um, just I think more empathy. Sure.

Carrie: 25:29

I love that. And I also love what you were saying about keep trying. Um, we kind of have a saying around here. It's not, I can't. It's, I can't yet. Ah, I love that. So, there you go. But, and again, we want to thank you so much for joining us, Carol. I've loved this conversation. I've loved getting to know you a little bit better more than just through email. It's always nice to meet people in person. So again, we appreciate you taking the time to visit us. And we thanks to all of our listeners for listening.

Kezia: 25:53

And, of course, I want to thank you again. Um, of course, to all of our listeners, if you want to contact us, or our guests, make sure to just email us at bindwaves at the bind dot org. We normally do also have the resource emails, um, or any contact information down below in our description. And also, follow us on Instagram if you don't already, and if you do, uh, tell other people to copy you and follow BINDWAVES, and visit our website. which is thebind.org/BINDWAVES.

Carrie: 26:26

And once again, don't forget to like, share, and subscribe on whatever your favorite platform is. Again, hit that notify button on YouTube so that you can continue listening to BINDWAVES.

Kezia: 26:37

Every Thursday, if you don't know already, make sure to listen to the new episodes on all of your platforms. So until next time.

Carrie: 26:47

Until next time!

26:48

We hope you've enjoyed listening to BIND Waves and continue to support BIND and our non profit mission. We support brain injury survivors as they reconnect into the life, the community, and their workplace. And we couldn't do that without great listeners like you. We appreciate each and every one of you. Continue watching. Until next time. Until next time.