Selecting a Rehabilitation Facility After Brain Injury

Selecting a rehab facility is a crucial decision. It should not be rushed. There are hundreds of rehabilitation programs. They vary considerably in the philosophy, quality, and variety of the services they offer.

I was in no condition — physically or mentally — to carefully research, visit, and compare rehab facilities. I relied heavily on my sister Barbara to handle this. You may want to ask someone to help you with this time-consuming job.

To start your search, compile a list of rehabilitation facilities to consider. Ask for recommendations from the following folks:

• The hospital social worker or case manager
• The physicians treating your survivor
• Your family doctor
• Your health insurance company, as your choices may be limited by your policy
• Your state brain injury association
• Families with rehab experience
• The Brain Injury Association of America has an online searchable database which includes a list of rehab programs (800-444-6443 & www.biausa.org).
• If your employer offers an Employee Assistance Program (EAP) or a Life Events Benefit, it may include Adult/Elder Resource and Referral Services, which may help you identify facilities in your area or elsewhere.

I believe that one factor — proximity to your home — is paramount in the selection of a rehabilitation facility. As I wrote earlier, support from family and friends during rehab is an invaluable motivator for the survivor. If the rehab facility is close to home, this support role can be shared. If it’s far from home, supporting the individual typically falls on just one person — usually Mom — or no one at all.

It also is easier to participate in decisions to be made about your survivor’s care and to monitor the way she is treated at the rehab facility, if it’s convenient for you to be there frequently.

The choice of a rehabilitation program, however, should not be based solely on location. Some folks who live in more rural areas have no choice but to travel a long way to a rehab facility.

To help you begin your selection process, here’s a list of fourteen services every brain injury rehab program should have:

1. Evaluation and assessment of the patient's unique physical, cognitive, communication, emotional, behavioral, and social impairments
2. Physical therapy to regain mobility, strength, balance, coordination, and endurance
3. Occupational therapy to relearn self-care and daily living skills
4. Speech and language therapy to treat communication and swallowing disorders
5. Cognitive rehabilitation to treat deficits in attention, concentration, memory, problem-solving, planning, and decision-making
6. Neuropsychology or rehabilitation psychology to help the survivor accept the consequences of her injury and to treat any emotional and behavioral problems
7. A social skills group to relearn how to interact with others
8. Recreational therapy to relearn leisure skills and, maybe, develop new interests
9. Access to other medical specialists, such as neurologists, orthopedists, and pain management doctors, to provide treatment for other medical problems
10. Education for both the patient and the family in living with a brain injury
11. Family counseling to help everyone adjust to their survivor’s impairments
12. Substance abuse counseling
13. Trips outside the rehab center to reacquaint the survivor with the community and to determine any special needs
14. Vocational therapy to help higher-functioning survivors return to work

All staff members should be well trained and experienced in treating people with brain injuries. If the facility uses students, interns, or less experienced therapists, they should be monitored closely by seasoned practitioners.

The staff of a rehabilitation facility should include:

• A board certified physiatrist or neurologist as the team leader
• A neuropsychologist or a rehabilitation psychologist
• Physical, occupational, speech, recreational, and vocational therapists
• A rehabilitation nurse who will assist the patient with her therapy homework in the evening and on weekends
• A clinical dietitian, as survivors often have little appetite when they begin rehab
• A case manager who will negotiate with your health insurer the duration of your survivor’s therapy

When evaluating rehabilitation facilities, it’s best to visit at least twice, the first time with an appointment, the second time unannounced.

Here are ten things to look for as you inspect the facility:

1. Cleanliness
2. Adequate space for many different types of therapy
3. Staff professionalism, attention, and compassion for their patients
4. Openness: Do you feel welcome observing activities, walking around, and asking questions?
5. Are the patients clean and well kept?
6. Do they appear content with their treatment?
7. Is the food appealing?
8. Is there a home orientation suite, which enables the patient to practice skills in a home setting?
9. Do you feel rushed or pressured?
10. Are there conveniences for families, such as a cafeteria, meditation room, clergy, and lounges?

Don’t be swayed by how nice the facilities appear or how wonderful a brochure looks. Ask questions. Record the answers so you can compare facilities later. Consider using a tape player to record conversations and your impressions of the facility. Also, don’t be shy about approaching families with patients at the facility. They are valuable sources of information.

Next: Questions to Ask >