Comprehensive Community Rehabilitation Care for Brain Injuries

1. ABI Commission8/1/2011 Community Rehab Care Ann Gillespie, MBA - COO Community Support Associates, Inc. Jill Beardsley, MA,CAGS, LRC - Director

2. Services Offered: • CRC: • Licensed as out patient rehabilitation clinics • CARF accredited • Community based offering skilled: Physical, Occupational, Speech Therapy, Neuropsychology, Social Work and Case Management • Real world-functional • CSA: • Community-based residential, case management, and recreational programs for adults with TBI • Vocational services for adults with disabilities • Functional, cognitive-behavioral approach

3. Services offered: • CRC: • SHIP Case Management & Community Service Workers • Rolland Nursing Home Initiative • ABI Waiver • SHIP Recreation Groups • CSA: • SHIP Multi-Service Center including Outreach, Support Coordination, Individual Skills Training, Long-Term Supports • ABI Waiver • Rolland Nursing Home Initiative • Private case management/supported living • SHIP Residential Programs • SHIP Recreational Program

4. Geographic Areas Served: • CRC: • Clinics in storefronts in Newton, Medford and Quincy • Geographic area from Amesbury to Truro and West to Worcester • Clients will travel over an hour to get to CRC • CSA: • Three residential programs in Hyannis • Multi-Service, Vocational, and Recreational programs serve clients from Provincetown to Wareham, Martha’s Vineyard and Nantucket

5. Population Served: • CRC: • Specializes in Neurological clients • TBI: MVA, falls, assaults, gunshot wounds, etc. • Stroke: (esp. young stroke) • Aneurysms • Brain tumors • Anoxia from Cardiac arrest and Drug overdose • CSA: • Often dictated by SHIP funding limits - TBI is primary disability; some outreach services to ABI individuals (average 30% of outreach referrals) • Vocational services to all disability groups

6. Funding for these services: • CRC: • We accept all insurances including Mass Health and Medicare • State funding: SHIP, MRC • Private pay • Rolland & Hutchinson • CSA: • State funding: SHIP, MRC • Private Pay, Worker’s Comp • Rolland and Hutchinson

7. Case Study“Sue” • Sue is 20 yrs old with multiple surgeries due to a brain tumor • 2 years later she has Left CVA • Lives with parents and younger siblings • Prior to surgery she was an honor roll student and ballerina on her way to college • Issues with memory, impulsivity, judgement • Paranoia

8. “Sue” • PT: able to walk 15 min. with proper gait and control her movements. Achieved these goals • PT discharge: Follow her home exercise program and supervised walking to maintain activity tolerance • One on one Pilates program/class

9. “Sue” CRC: • OT: • Able to complete a routine ADL schedule • Learning strategies for dressing independently • Developed a structured home routine • Used pillbox with alarm • OT Discharge: • Follow up with:using transportation in community • Follow through with a day program and leisure activity • Continue with volunteer activity

10. “Sue” • CRC: • Speech: • Dependent for personal affairs, home organization, appropriate socialization, safely maintain health and wellness. • At risk for social isolation, depression and further hospitalization. • Speech Discharge: • Use memory planner to help with day • Use speech strategies for intelligibility • Use attention based strategies i.e.. Slow down, double check, clear workspace, etc to complete complex tasks

11. “Sue” • Speech discharge: • Attend support groups for recreation • Frequently engage in social events • Explore potential day programs and recreation events

12. “Sue” – Post-discharge • Family provided in-home care through Caregiver Homes • Lack of structure resulted in decreased functioning • No funding to supervise volunteer activity • Distance of rec. group prohibitive (no public transportation) • Admitted to day program for autistic adults(35 miles away; no public transportation) • Discharged from day program due to unsafe, impulsive behaviors (7:1 client to staff ratio) • Family feels she needs residential program – cannot handle with sibs in house

13. Gaps in Services for ABI • CRC: • For those with Stroke, aneurysms, brain tumors there are barely any services outside of support groups • Trained staff to treat in the community like counselors, neuropsychologists and case managers • Substance or dual diagnosis programs that are familiar with neurological issues. • CSA: • In-home case management services • For some, minimal services = maximum gain • Existing providers familiar with needs of older population, not younger survivors (i.e., stroke)

14. Gaps in Service for ABI • CRC: • No Adult funding mechanisms to provide on going care. • CSA: • SHIP funding limited to Traumatic Brain Injury • Mass Health does not fund community based ABI services outside of waiver eligible

15. Gaps in Services for ABI • CRC: • Day services • Housing • The RIDE does not serve several areas on the North Shore, (i.e.. Boxford, N Reading); no other options • CSA: • Day programs geared toward DD/elders, not ABI • Waitlists for housing 5-13 years; Section 8 rental caps much lower than market rent • Limited transportation routes/hours, no evenings, weekends

16. Gaps in Services for ABI • CRC: • Lack of rehab for cognitive therapy. Hospitals focus on physical needs (i.e.. swallowing, PT, OT) • Limited to no vocational programs for training clients with return to work skills • CSA: • No cognitive therapy programs on Cape; SLPs not always familiar • Pre-vocational services (volunteer placement, skill training)

17. Gaps in Services for ABI • CRC: • Independent living center in Salem is a great resource for people with disabilities, but not necessarily focused on ABI • No supportive housing or group homes • CSA: • Independent living center in Hyannis does not accommodate cognitive needs of ABI • No funding for supported living

18. Gaps in Services for ABI • Supportive living model is about directing your care, and ABI clients cannot do this. So then they need a surrogate but who pays for that? • Lack of assistive technology interventions • There may be access to substance abuse and psychiatric help but the ABI does not fit the model