Here are some questions to ask:
- The Rehabilitation Program
- The Role of the Family
- The Rehabilitation Team
- Behavioral Problems
- Cognitive Impairments
- Daily Living
- Discharge Planning
- Paying the Bills
The Rehabilitation Program
- How long has the program existed?
- Is the program CARF-accredited? The Commission on Accreditation of Rehabilitation Facilities (CARF) sets quality standards for rehab programs. If the program isn’t accredited, be wary and ask why not. You can obtain a list of CARF-accredited providers by calling 866-888-1122 or at www.carf.org.
- What is the staff-to-patient ratio?
- Are special accommodations made for special populations, such as children, seniors, and drug and alcohol abusers?
- How many people with brain injuries has the facility treated?
- How many people does the facility treat at one time?
- What is the average length of stay?
- Who determines the length of stay?
- How flexible is the program? We were very disappointed with our program’s lack of flexibility. Jessica was anxious to improve her soft and halting speech. But her request for more speech therapy and less recreational therapy — which she felt was a waste of time — could not be accommodated.
- Does the program maintain records on patient outcomes?
- Does the facility provide outpatient rehabilitation? This allows for a smooth transition from inpatient to outpatient therapy, which is helpful since you and your survivor will be coping with many other issues when she returns home.
- How often will you be able to speak to the doctor who heads your patient’s treatment team?
- Is it possible to get the names and contact information for three or four survivors and their families who completed the program? I didn’t do this and I wish I had. I might have been more aware of problems with the program and acted more quickly to correct them.
- What are the program’s weaknesses? What services do you not provide?
- What recourse is there if you question or disagree with the quality or necessity of services being provided?
The Role of the Family
- What role do family and friends play in the program?
- Is the family welcome to regularly attend therapy sessions? If the answer is “No,” you may want to look elsewhere.
- What is the visitation policy? Family and friends should be allowed to visit at any time.
- Can a family member sleep in the survivor’s room?
- Are there regularly scheduled meetings with the family? How frequently? An initial meeting should be held to discuss the patient’s impairments and rehab goals. Then, all parties should meet again at the halfway point to discuss the patient’s progress. A third meeting should be held to discuss the patient’s homecoming and need for additional therapy.
- Is reading material available to educate the family about brain injury?
- If you live far away, how much telephone contact will there be with the patient and the medical staff?
- Also, what housing arrangements can be made for you?
The Rehabilitation Team
- What are the rehab team members’ credentials?
- How long has each team member been on staff?
- How frequently do team members meet to discuss a patient's condition?
- Will you have access to all team members?
- How are student therapists used in the program? Jessica frequently had a student speech therapist, who was not monitored closely by a more experienced staff member.
Addressing Behavioral Problems
- How does the program treat behavioral problems?
- Are restraints, safe rooms, secure and/or locked rooms used? In what circumstances?
- Is the family consulted about the use of them?
Addressing Cognitive Impairments
- What approaches are used to treat cognitive deficits?
- Is neuropsychological testing used to determine the patient’s core cognitive problems?
- If neuropsychological testing is not performed, how are cognitive problems diagnosed?
- How are the results of these tests used?
- Are patients retested at a later date to determine progress?
- What are the rights and responsibilities of the patient?
- Is there therapy on Saturday and Sunday? Jessica had therapy only on Saturday mornings. These sessions, which were led by a junior therapist in a group setting, were a waste of time and precious health care dollars.
- What will your survivor do in the evening and on weekends? Jessica found Sundays unbearably boring, especially near the end of her stay when she was desperate to go home.
- How frequently is the patient bathed?
- How many workers are on the night shift? What are their responsibilities? Jessica dreaded nighttime. She had difficulty sleeping, was not allowed to go to the bathroom by herself, and often found the night staff indifferent to her needs. We later learned that this is common in many facilities.
- Can the program accommodate any special cultural or religious needs?
- How does the program accommodate special diets and personal food preferences?
- Is outside food permitted for your patient? Jessica had little appetite and was shedding pounds. I was able to tempt her a bit with her favorite foods.
- Are conjugal visits allowed?
- How long will your survivor be at the facility?
- Who decides when inpatient rehab ends?
- How is this decision made?
- Where will your survivor go after inpatient rehab?
- What role does the survivor and family have in these decisions?
- Does the staff teach the family how to cope with their survivor's impairments when she returns home?
- Does the staff teach the family how to continue rehab at home?
- How is the patient prepared for going home?
- Will therapists visit your home and help you prepare for the special needs of your survivor?
- Will your survivor be allowed home visits before she completes the program? Home visits provide a clearer picture of a patient’s functional problems and should be used to identify therapy goals and exercises.
- Are there follow-up services after discharge? How frequently? We had five follow-up appointments with the doctor who headed Jessica’s rehab team.
Paying the Bills
- How much does the program cost?
- How much of this cost will your insurer pay?
- Are there any charges not covered by insurance?
- How much will you pay out-of-pocket?
- How much flexibility is there with your insurer? We were able to obtain extra outpatient therapy sessions by agreeing to leave inpatient rehab a week early. This worked well because both Jessica and I were ready for her to go home.
This article on rehabilitation after a brain injury is excerpted from Garry Prowe's book, Successfully Surviving a Brain Injury: A Family Guidebook.
In 1997, Garry's wife, Jessica, sustained a severe brain injury in an automobile crash. "At the time, I spent way too much time accumulating the information I needed, not only to understand the medical aspects of Jessica's brain injury, but also to handle the myriad insurance, financial, legal, personal, and family issues that accompany a serious blow to the brain. I recognized the need — that still exists today — for a book that comprehensively addresses the wide variety of issues families face in the first few months after a brain injury.
"To research this book, I assembled a panel of more than 300 survivors, caregivers, and medical professionals who responded to my email questions and reviewed portions of my writing.
"For us, this project is a labor of love. All profits from the sale of this book will be donated to brain injury organizations."
From Sucessfully Surviving a Brain Injury: A Family Guidebook by Garry Prowe, Brain Injury Success Books, © 2010 Garry Prowe. Used with permission. www.BrainInjurySuccess.org.