Issues surrounding the discharge of the brain-injured person from an acute care hospital.

Options for Rehabilitation Facilities

The following program/service categories describe the array of organized services (not mutually exclusive) and not an exhaustive list available for the rehabilitation of persons with brain injury.

Acute Rehabilitation - Based in a medical facility; accepts patient as soon as medically stable; focused on intensive physical and cognitive restoration services in early months after injury; typical length of stay one week to several months (short term); identifiable team and program with specialized unit.

Behavior Disorders - For the patient exhibiting patterns of behavior preventing participation in active rehabilitation, including destructive patient behavior to self and others; continuum of controlled settings.

Case Management - Services designed to maximize the effective use of resources and to achieve the highest level of functioning. Case management services may include assessment of client needs, development or a plan based on needs and goals, identification of programs, services, practitioners and funding resources, coordination and monitoring of services, and ongoing evaluation of current and future needs.

Coma Management - Accepts patients as soon as active intervention is indicated; Patient functioning at Rancho Los Amigos Scale levels I-IV; and unable to actively participate in therapy.

Community Integration Program - Provides services designed to accomplish functional outcomes focused on home and community integration, including productive activity. Services may be provided in residential facilities, day treatment programs, the consumer's home. They may be of short-term (several weeks) or long-term duration (several months).

Community/Home Services - Services are provided in the client's home and/or the client's own community. Personnel providing services must have appropriate qualifications and training to meet the client's needs. (Adopted by the Post-Acute Committee of ISIG on Head Injury October 28, 1991.)

Congregate Living - Setting is a shared living arrangement in a dormitory style facility. Individual care, supervision, support and training services are provided to maintain/promote self-sufficiency. Staff is present at night and other times when the consumer is present.

Day Treatment Programs - Non-residential program intended to increase the functional ability of the consumer through therapeutic intervention and supervised activities. Day treatment seeks to facilitate successful community integration.

Education Program - Provides primary, secondary, and/or higher level education and support services to achieve realistic academic goals. May include evaluation, academic tutoring, school reentry services and/or General Education Diploma (GED) preparation.

Employment - Vocational rehabilitation services that are designed to lead to an employment goal; services can range from assessment to basic on-the-job supports; includes one or all of the following: vocational assessment, vocational training, vocational placement, sheltered employment, supported employment.

Family Living - Setting is the home of a family other than the family of origin of the consumer. Through a contractual relationship, a family environment is provided to maximize the consumer's potential. Monitoring, support and training are provided by the organization offering the program.

Home care - Comprehensive training available for family/caretaker; case management services available prior to home care; team integrated home program.

Independent Living - Community-based to maximize a person's ability to be empowered and self-directed; allows an individual to live in one's own home with maximum personal control over how services are delivered, combined with the opportunity to work as appropriate.

Lifelong Living - For persons discharged from rehabilitation who need ongoing lifetime supports; located in residential or skilled nursing environment; structured activities available on individual and group basis.

Long-term Medical Inpatient Program - Designed to improve the functional ability of a severely disabled person through a long-term program of coordinated medical and rehabilitation services. The resident typically has significant limitations in functional capabilities, both physically and cognitively. The program is generally provided on a specialized unit within a hospital; the staff is trained in managing problems exhibited by persons with severe disabilities. Residents are accepted as soon as medically stable.

Medical Inpatient Program - Designed to improve the functional ability of the patient through a coordinated program of medical care, evaluation and intensive rehabilitation services. The program is generally provided on a specialized unit within a hospital; the staff is trained in rehabilitation of persons with TBI. Consumers are accepted as soon as medically stable and typically remain in this program 1-3 months. (See acute rehabilitation.)

Nursing Facility - Long-term care facility which provides 24-hour skilled nursing care prescribed by a physician.

Outpatient/Day Services - Services are usually delivered (or coordinated) in a fixed location during some portion of the day. The environment must have adequate amenities to meet health safety and dignity needs of the client. Services must be provided by personnel with appropriate qualifications and training to meet the client's needs. (Adopted by the Post-Acute Committee of ISIG of Head Injury, October 28, 1991.)

Outpatient Medical Rehabilitation - Provides coordinated and integrated evaluation and treatment with an emphasis on improving the functional abilities of the client. At minimum must include medical supervision, medical support services and consultation, rehabilitation therapies and other services.

Recreation Programs - Program designed to enhance participation in social and recreational activities and/or the development of recreational skills.

Residential Services - Assumes a 24-hour residential environment outside the home and includes 24-hour provision of or access to support personnel capable of meeting the client's needs. (Adopted by the Post Acute Committee of ISIG on Head Injury October 28, 1991.)

Respite Care - A program or plan designed to provide time-limited relief to the family or other primary care giver from the ongoing responsibilities of care giving.

Respite/Recreation - Program allows person and family to adapt psychologically and environmentally to the residual deficits of brain injury; the program is based on a non-interventional model to address socialization, recreation, and respite for the primary care givers.

Subacute - May follow a period of acute rehabilitation; not necessarily hospital based; typical length of rehabilitation stay 6-24 months (short to intermediate term); stay based on demonstrated improvement; identifiable team and program with specialized unit.

Supervised Living - Setting is a home which is like other homes in the neighborhood in terms of size and number of residents. Consumers are provided individualized care, supervision, support and training services to maximize and/or maintain function and self-direction. Staff is present at night and other times when the consumer is present.

Supported Independent Living - Setting is a home chosen by the consumer who is primarily independent. Program offers support to assist the resident in maximizing and/or maintaining independence and self-direction. Staff is available as needed and at planned intervals to offer assistance and support but not to provide supervision.

Transitional Living - Non-medical residential program providing training for living in a setting of greater independence. The primary focus is on teaching functional skills and compensating for abilities that cannot be restored.

Vocational Evaluation - An organized and comprehensive service staffed by specialists who systematically and comprehensively utilize work activities (real or simulated) and/or educational services as the focal point for educational and vocational assessment and exploration. In addition, psychological testing, counseling, social summaries, occupational information, etc., are other evaluation tools that are used. It incorporates the medical, psychological and economic data for establishment and attainment of individual goals.

Vocational Rehabilitation Program - Offers employment services which may include vocational evaluation, skill training, work adjustment, job training, job placement, job coaching, sheltered and/or supported employment.



Support Systems



Please visit the advocacy section in Legal and Financial Issues for additional information regarding home care, rehabilitation and support systems.

Issues in Home Care

Options for Rehabilitation Facilities

Medical Assistance Waiver



Attorney Gordon S. Johnson, Jr.

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