Standards of care for Neuro-rehabilitation — Brain Injury – the internal storm

Several weeks ago I had the opportunity to participate in an event at Salford Royal Hospital to discuss and set the standards for neuro-rehabilitation services in the Greater Manchester area where I live. This rare event brought all manner of people from the neurological community including lead clinicians, managers, clinical commissioners, therapists, charity representatives, patient support groups, […]

via Standards of care for Neuro-rehabilitation — Brain Injury – the internal storm


Author: brokenbrilliant

I am a long-term multiple (mild) Traumatic Brain Injury (mTBI or TBI) survivor who experienced assaults, falls, car accidents, sports-related injuries in the 1960s, '70s, '80s, and '90s. My last mild TBI was in 2004, but it was definitely the worst of the lot. I never received medical treatment for my injuries, some of which were sports injuries (and you have to get back in the game!), but I have been living very successfully with cognitive/behavioral (social, emotional, functional) symptoms and complications since I was a young kid. I’ve done it so well, in fact, that virtually nobody knows that I sustained those injuries… and the folks who do know, haven’t fully realized just how it’s impacted my life. It has impacted my life, however. In serious and debilitating ways. I’m coming out from behind the shields I’ve put up, in hopes of successfully addressing my own (invisible) challenges and helping others to see that sustaining a TBI is not the end of the world, and they can, in fact, live happy, fulfilled, productive lives in spite of it all.

4 thoughts on “Standards of care for Neuro-rehabilitation — Brain Injury – the internal storm”

  1. Thank you for the courage it takes to stand up for vulnerable people. These companies care little about the people they serve. They only care about making money and nothing more. They put people with brain injuries in stressful situations to keep the money flowing. This is from the final report of the Congressional Investigation on abuses of the brain injury industry:

    • In 1988, the House and Senate Committees on Appropriations prompted the Federal Government into action, by encouraging the establishment of an Inter agency Task Force, consisting of 13 Federal Agencies, and chaired by the Director of the National Institute of Neurological Disorders and Stroke at the National Institute of Health. These representatives outlined six recommendations and 47 related implementation issues, which together described a lack of leadership by federal and state governments, as well as the private sector, in providing appropriate services for people with brain injuries. Among the issues identified as requiring immediate attention were the lack of access to care, poor coordination of existing services, inappropriate licensing and over-site of facilities, and lack of cost control mechanisms (3).

    • Patient advocates contended at the hearing that the institutional model rehabilitation facilities utilized (medical model) were overpriced and overused. At a cost averaging $20,000 to $30,000 per month, abusive providers can quickly drain insurance benefits that people with brain injuries will need for rehabilitation and long term care, forcing them onto Medicaid and leaving the tax payer to support their care. The report goes on to say: State Medicaid programs have become a dumping ground for rehabilitation chains and nursing facilities once the individuals insurance money runs out. These institutions are not only more expensive, but the treatment they provide is of unproven value (4).

    • Routinely sending people with brain injuries far from their homes is an abuse of the 1965 amendment to the Social Security Act, which established the Medicaid program. Medicaid directs states to determine rates for medical services and authorizes state programs to pay for “unique and necessary services,” from providers in other states when appropriate medical facilities are not available locally (5). Multi-chain nursing homes and rehabilitation facilities have exploited this exception to insure greater profits by not admitting patients in in-state facilities. Out of state placements significantly strain brain injured people as well as their families. A familiar non-stressful environment, assisted living, community and family supports are identified as essential components to successful brain injury rehabilitation programs. Institutional placements away from one’s home are counterproductive (6).

    Sadly, today these types of abuses have continued even after the congressional investigation and FBI raids on New Medico. Recent articles by David Armstrong at Bloomberg News has brought to light a new round of fraud and abuse at the Florida Institute for Rehabilitation (FINR) which is owned by the son of the owner of New Medico. FINR has recently filed bankruptcy after people with brain injuries were reportedly beaten by staff when they didn’t comply with facility rules. Today, estimates range from $70 to $100 billion a year to treat brain injuries. One study said the overall costs of brain injury – wage loss, law enforcement, courts, etc. is over $300 billion annually.


  2. I reblogged this from another website. WordPress doesn’t do a very good job of indicating reblogging, so sometimes it looks like those are my words. But they’re really not. I hope there’s no confusion.


  3. No Problem. I liked what he said and glad he is putting this out. Thanks for rebloging it. Standards need to be set and maybe this will help.

    Liked by 1 person

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