Community Rehab CareAnn Gillespie, MBA - COO

Community Support Associates, Inc.Jill Beardsley, MA,CAGS, LRC - Director

Services Offered:CRC:Licensed as out patient

rehabilitation clinicsCARF accreditedCommunity 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

Services offered:CRC:SHIP Case

Management & Community Service Workers

Rolland Nursing Home Initiative

ABI WaiverSHIP Recreation

Groups

CSA:SHIP Multi-Service Center

including Outreach, Support Coordination, Individual Skills Training, Long-Term Supports

ABI WaiverRolland Nursing Home

InitiativePrivate case

management/supported living

SHIP Residential ProgramsSHIP Recreational Program

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 HyannisMulti-Service,

Vocational, and Recreational programs serve clients from Provincetown to Wareham, Martha’s Vineyard and Nantucket

Population Served:CRC:Specializes in

Neurological clientsTBI: MVA, falls,

assaults, gunshot wounds, etc.

Stroke: (esp. young stroke)

AneurysmsBrain tumorsAnoxia 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

Funding for these services:CRC:We accept all

insurances including Mass Health and Medicare

State funding: SHIP, MRC

Private payRolland &

Hutchinson

CSA:State funding: SHIP,

MRCPrivate Pay,

Worker’s CompRolland and

Hutchinson

Case Study“Sue”Sue is 20 yrs old with multiple surgeries due to a brain tumor2 years later she has Left CVALives with parents and younger siblingsPrior to surgery she was an honor roll student and ballerina on her way to college

Issues with memory, impulsivity, judgement

Paranoia

“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

“Sue” CRC:OT:Able to complete a routine ADL scheduleLearning strategies for dressing independentlyDeveloped a structured home routineUsed 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

“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 dayUse speech strategies

for intelligibilityUse attention based

strategies i.e.. Slow down, double check, clear workspace, etc to complete complex tasks

“Sue” Speech discharge:Attend support

groups for recreation

Frequently engage in social events

Explore potential day programs and recreation events

“Sue” – Post-dischargeFamily 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

Gaps in Services for ABICRC: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)

Gaps in Service for ABICRC: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

Gaps in Services for ABICRC:Day servicesHousingThe 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

Gaps in Services for ABICRC: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)

Gaps in Services for ABICRC: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

Gaps in Services for ABISupportive 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