Welcome to the TBI-HELP Live Chat

Today's topic is: "Caregiving and Discharge Planning Issues"

Our Guest is: Ms. Noreen Bock, CSW, Jamaica Hospital Medical Center, Traumatic Brain Injury Unit

[19:00:29] Mod: Welcome! Tonight we have as our guest speaker Ms. Noreen Bock, CSW, from Jamaica Hospital Medical Center Traumatic Brain Injury Unit. Welcome Noreen.
[19:00:44] Noreen:
[19:02:02] Noreen: Hello I'm happy to be here tonight
[19:03:15] Mod: Ms. Bock - How often is the TBI discharge to the patient's home rather than some intermediate care facility?
[19:04:22] Noreen: It depends, sometimes the patient is not quite ready to return home and additional therapy is required to try to get the patient as independent as possible
[19:05:19] Mod: What do you mean by additional therapy and where does this therapy take place?
[19:06:58] Noreen: In answer to your question Gerri, additional therapy would take place in a sub- acute facility. Therapies would include PT OT Speech And cognitive but on a sub acute level
[19:08:07] Mod: Andy: How do you assess when a patient is ready to leave and whether they can go home or to another facility?
[19:10:50] Noreen: In answer to your question Andy, The MD and entire treatment team make the decision when patient is ready for discharge. These recommendations are given to the patient and family. In the end the family makes the decision whether they can manage patient at home or go to another facility
[19:10:58] Mod: Rail: Is there an 'independence scale' that can guide the family in making informed preparations for the patients' return home?
[19:14:26] Noreen: In answer to your question Rail, There is no independence scale that we use however I would suggest that the family spend time on the unit with the patient and therapists during treatment sessions, this way the family can see first hand what the patient needs, what equipment might be needed and it also gives the family an opportunity to ask questions
[19:14:30] Mod: Melanie: I never really understood the procedure for PRI's going out. They really contain some little info other than life support and type of illness with letter thought to type of therapy needed as in the case of someone with a TBI. Perhaps you could help clear this up. Do they go out to all facilities in general area regardless of whether the patient may live or their needs? Unfortunately until recently there were not too many places that specialized in TBI.
[19:17:42] Noreen: In answer to your question Melanie, You are correct in saying that there are not many sub-acute TBI facilities. When there is a TBI patient we generally send the PRI'S to these facilities. We try to accommodate the family and patient as much as possible to get the area they want
[19:17:55] Mod: Hi Carol: How do you assist families that are fearful of taking a patient who has sustained a TBI home?
[19:20:16] Noreen: Carol, It is important to have family meetings whereby all members of the treatment team are present as well as the family. I feel it is the teams job to provide the family with as much information as possible
[19:21:51] Mod: Melanie: It would be ideal if an OT could go to ever home, make suggestions about modifications, help order all equipment to an get home care in place before someone even gets home.  I've seen that done and it makes a wonderfully "safe" discharge.
[19:22:56] Noreen: I agree Melanie
[19:23:15] Mod: Anne: What are some of the services available to help families that care for TBI patients at home and have very little or no help? Annie: Many times the TBI patient themselves are very fearful of going home and even resist this...how can you help someone to overcome this?
[19:26:26] Noreen: Annie, Unfortunately this happens often the family is the main caregiver. I sometimes suggest contacting religious organizations, senior citizen agencies sometimes town newspapers often have people looking to help out. This can be very frustrating for a family. Again it is important for the team to provide the patient with as much information as possible, make appropriate referrals and make sure the family has a good understanding of patients needs
[19:28:25] Mod: Rail: In line with what "Melanie" is saying is there a pre-discharge checklist that could be used for the family to evaluate the home for "safety" and needed equipment. If it could be created we could put it on the Site.
[19:31:12] Noreen: This is a good suggestion Rail , The therapist will go over all equipment with the patient and the family before discharge. Once the patient is home, the home therapist can make further recommendations.
[19:31:19] Mod: Anne: Frustrating isn't the word...I do everything myself...and get no help...any churches or places in Queens I can call?
[19:33:55] Noreen: In answer to your question Anne you could check with your local parish or local senior center or the Long Island head injury association
[19:34:01] Mod: Chris: Is there anyway to check to see if the rehab. ctr. or the nursing home someone recommends you is ok or not?
[19:35:12] Mod: Melanie: Anne, start with the insurance company Medicaid or whatever pays for hosp. care and see about home care. You might have to fight for it but its worth it. Then when you get it you still have to teach the necessary skills to the HA.
[19:36:26] Noreen: Chris in answer to your question there are organizations one that I know of is FRIA, however I am not sure of the number. When visiting facilities I also recommend asking to see their state survey
[19:37:46] Mod: Melanie: Now that adult day programs are becoming so popular can they be included in discharge planning? They provide wonderful socialization as well as therapy and them out in the world. They also give the caregiver a much needed break.
[19:39:44] Noreen: Melanie , Adult Day Programs can be a good discharge planning option, however if you do not have active Medicaid it is private pay and these places can be very expensive
[19:39:53] Mod: What can the family do to cope with the role of the caregiver?
[19:41:15] Noreen: It is important to find support systems, family, friends, anyone who may be able to give you a respite from caregiving. Find support groups- It is helpful to talk with others who are dealing with the same issues as your are. Find out information on TBI websites, web sites can provide important information that may be helpful. Contact your local head injury association. The most important thing is to take time for yourself, this will help you to refresh and continue your role as caregiver
[19:44:20] Mod: As a caregiver I sometimes feel many different feelings, anger frustration and feel guilty about this? Are these normal?
[19:46:02] Noreen: These feelings are normal, a brain injury affects the whole family and can be a life altering experience especially for the person designated as caregiver. Never feel guilty about your feelings you have the right to feel any emotions that you have. It is very important to identify and address these feelings. Do not ignore them.
[19:47:18] Mod: Chris: If someone goes to a sub-acute center or an NH will they ever get the care they would if they stayed in the hospital?
[19:49:33] Noreen: Chris , this question is difficult to answer because each facility is different
[19:50:42] Mod: Melanie: Most TBI symptoms do not stay the same. The personality changes sometimes for the better. The cognitive ability or physical deficits may get better with therapy. Fin a good physiatrist to help with new ways to keep up progress
[19:51:23] Mod: What should I know before the patient is discharged?
[19:53:02] Noreen: Medication, the dosage, time and possible side effects. Any medical symptoms that occur ex, headaches, dizziness, fatigue, anything unusual. If the patient is receiving homecare, you need to know the type of homecare services you will be receiving ex, RN, HHA, PT<OT<Speech or cognitive therapy Also what services will be covered under your insurance and for how long. If receiving out-patient services, you will need to know what out-pts are contracted with your insurance, how many visits are allowed and who will provide transportation. You will need to know type of equipment the patient will need at home- What will be covered by insurance and what wont and who orders the equipment. Find out if the patient will be given an exercise program in addition to therapy. Find out if the patient will require any cognitive/behavioral tools ex, memory book, daily planners, calendars, pill case reminders and stop watches. The SW works with case management and homecare to set up services. The social worker orders all equipment.
[20:01:21] Mod: I want to take this opportunity to thank Ms. Bock for participating in our chat this evening and welcome her to speak again. Good Night and be safe!
[20:01:46] Noreen: Thank you I enjoyed this