Scope of Services

Intensive Neurobehavioral Rehabilitation, Transitional and Supported Living Programs:

Scope of Services

 General Program Descriptions:

The programs of the NRI Intensive Neurobehavioral, Transitional and Supported Living Centers are designed to assist the participants in maximizing their independence in inpatient and community-based care environments in preparation for a return to home and  less structured, community care programs. The NRI programs: Complex Care Rehabilitation, Intensive Neurobehavioral Rehabilitation, Brain Injury Dual Diagnosis Rehabilitation and the Transitional and Supported Living Center programs provide functionally based neurobehavioral rehabilitation to individuals with acquired or traumatic brain injury; development disorders; neurologic diseases and behavioral health problems.

Complex Care Rehabilitation program:

The Complex Care Rehabilitation program is a hospital based program for individuals who are “slow-to-recover” with high medical, nursing and supervision needs due to low and or erratic levels of arousal and attention accompanied by severe cognitive deficits and disorganized behavior. The program for each individual is structured to provide for the maximum amount of rehabilitation in a highly structured and monitored environment. The Complex Care Rehabilitation program is designed to assist the individual enhancing their level of independence and reducing their care and supervision needs to allow transition to community-based care.

Admission Criteria:

The admission criteria for the Complex Care Rehabilitation program is an adult individual with medical stability following a Traumatic or Acquired Brain Injury or other neurological illness or condition. Individuals requiring ongoing IV treatment, dialysis or infusion therapy will not be considered. Other specific conditions such as Wound Care will be evaluated on an individual basis. Individual care and support needs will be assessed and as required Enhanced Supervision needs will be determined.

Intensive Neurobehavioral Rehabilitation program:

The Intensive Neurobehavioral Rehabilitation program is a hospital based program for individuals who require a highly structured and controlled environment to address medical management and behavior therapy issues. The patient care unit is a segregated unit within a locked, secure hospital setting. Individuals participating in the program receive individualized services based on a rehabilitation treatment plan. The goal for all participants is to regain self-regulation and to access rehabilitation strategies needed for achieving greater independence. The NRI programs are designed to promote and enhance independence and to fully support the individual as they regain skills.

Admission criteria:

The admission criteria for the Intensive Neurobehavioral Rehabilitation program is an adult individual with medical stability following a Traumatic or Acquired Brain Injury or other neurological illness or condition. The individuals considered for admission will be evaluated to determine that their behavioral needs can be addressed in the program milieu and the level of additional supports and/or Enhanced Supervision required. Individuals requiring ongoing IV treatment, dialysis or infusion therapy will not be considered. Other specific conditions such as Wound Care will be evaluated on an individual basis. Individual care and support needs will be assessed and as required Enhanced Supervision needs will be determined.

Brain Injury Dual Diagnosis Rehabilitation program:

The Brain Injury Dual Diagnosis Rehabilitation program is a hospital based program for individuals with a moderate to severe brain injury and a co-occurring psychiatric or substance abuse problem which cannot be effectively managed in another rehabilitation environment. The individuals in the Brain Injury Dual Diagnosis Rehabilitation program exhibit a high degree of behavioral dyscontrol and significant cognitive impairments which create ongoing risk to self or others. Individuals who are actively using substances may receive medically supervised detox upon admission to the program. Individuals in the Brain Injury Dual Diagnosis Rehabilitation program receive a full compliment of NRI services and, upon stabilization and further assessment of the individual, participation in Behavioral Health and/or Substance Abuse individual and group services may be included as appropriate.  The goal of the program is to prepare the person for greater independence including improved symptom management in a community-based program.

Admission criteria:

The admission criteria for the Brain Injury Dual Diagnosis Rehabilitation program is an adult individual with medical stability following a Traumatic or Acquired Brain Injury or other neurological illness or condition. The individuals considered for admission will be evaluated to determine that their psychiatric, substance abuse treatment and behavioral needs can be addressed in the program milieu and the level of additional supports and/or Enhanced Supervision required. Individuals requiring ongoing IV treatment, dialysis or infusion therapy will not be considered. Other specific conditions such as Wound Care will be evaluated on an individual basis. Individual care and support needs will be assessed and as required Enhanced Supervision needs will be determined.

Discharge criteria:

Discharge criteria for all of the NRI Inpatient Medical Rehabilitation programs are based on the individual meeting the goals of treatment established in their treatment plan and demonstrating a capacity to move to a lower level of care with the NRI programs or in their home community. The goal of all of our programs is to enhance and promote independence and reduce the person’s needs for support and specialized care.

Levels of care:

NRI offers transition to the Transitional and Community Living programs for qualified individuals. The admission criteria for both programs include: individuals with Traumatic and/or Acquired Brain Injuries who are medically stable and not presenting with ongoing needs for medical supervision. Individuals in the program must be capable of performing a competent response in a home safety emergency with minimal assistance. Accept as specifically noted, all TLC and CLC residents must be independent or need minimal supports and cues to ADL activities and be able to participate in the requirements of structured group living.

The NRI Community programs provide care at two levels. The Transitional Living Center is a congregate living home located at 15323 East 13th Street, in the Radio Heights area. The TLC is a five-bedroom house providing accommodations for up to eight residents. The 4000 square foot home is located on over an acre in a quiet residential area of East Tulsa. The program in the 13th Street TLC is designed for individuals who are in the initial phase of transition from the more intensive, inpatient NRI program. The program offers a high staff/client ratio in the home and involves all residents in a full day program at NRI. The TLC program allows clients to practice behaviors and strategies in a more normal home environment and to further acquire the skills required to living with greater independence in the community.

The Supported Living program takes place at the Community Living Center (CLC), located at 5320 East 33rd Street. The residence is a duplex home consisting of two-two bedrooms, two bathroom apartments which share a kitchen and laundry. The 33rd Street property is located in an established area of midtown Tulsa and is close to shopping, recreational and community services.  Each apartment is approximately 900 square feet and provides a living room, dining area and two bedrooms. Clients living at the CLC experience greater independence in community living and mobility. Participants may be involved in a work readiness or supported employment program. Other individuals may continue with the day treatment program at the hospital where they will continue to acquire the cognitive and behavioral skills required for greater independence in the community.

Scope of Services: Summary:

The NRI Complex Care, Intensive Neurobehavioral and Brain Injury Dual Diagnosis Rehabilitation, and Transitional and Supported Living Programs provide comprehensive twenty four-hour care, including rehabilitative services to the clients participating in the program. Additional specialized treatment services are available through the hospital’s medical, professional and nursing staff and the Behavioral Health and Substance Abuse programs.  Clients residing at the TLC will attend the NRI program, located at Brookhaven Hospital, on a daily basis. This will enable them to maintain their participation in a highly structured program of rehabilitation services consistent with their individual rehabilitation plan. Physician and nursing supervision will be provided by the NRI Medical and Nursing staff.

Clients residing at the CLC will be participating in a program directed toward independence. The program will focus on providing the skills required for attaining greater independence in the community. This will include: home management, budgeting, shopping, meal preparation, laundry in addition to work readiness and/or supported or competitive employment activities. Clients participating in the CLC program, based on their rehabilitation plan, may attend NRI day treatment program services located at Brookhaven Hospital.

Meeting the Cultural, Ethnic, Religious and Personal Needs of the Persons Served:

The programs offered by NRI are sensitive to the cultural, ethnic, religious and personal needs of the persons served. The program gathers information on these needs from the individuals and their family members/significant others prior to and upon admission. Every effort is extended to meet these through program modification and, if required, additional services. Patients are encouraged to advise staff members of their personal preferences. The NRI programs and those of the hospital-at-large do not allow discrimination or bias to occur and support each individual’s cultural, ethnic, religious, sexual and gender needs and preferences.

Program History:

The NRI programs at Brookhaven Hospital have been in operation since 1984. NRI opened the first Transitional Living Center licensed by the State of Oklahoma in 1991. The TLC program offered transitional and supported living services to individuals who had received inpatient services in the NRI program and required additional rehabilitative and support services in a community-based setting. In 1999, the hospital acquired the Community Living Center on 33rd Street which allowed the program to develop an apartment based model for individuals with supported living needs. The Supported Living program provides an environment in which independent living skills can be furthered. Both the TLC and CLC programs represent NRI’s commitment to assisting each individual in achieving the highest level of independence available to them.

Achieving Goals from Inpatient Rehabilitation through Community-based Treatment:

The NRI programs are based on a functional skills acquisition model. This model of treatment emphasizes the learning/relearning of skills in the environment where the skill is required. Through repetition and practice, in all phases the program, skill learning can be maximized. All staff are trained in the implementation of each client’s rehabilitation plan and apply the appropriate strategies and interventions to address cognitive, behavioral, psychological/emotional and physiological problems which are identified in the rehabilitation plan. Consistent with the NRI Intensive Neurobehavioral Rehabilitation model, the TLC and CLC programs offer each client multiple opportunities to practice skills.

Community-based Treatment:

The NRI programs are based on a functional skills acquisition model. This model of treatment emphasizes the learning/relearning of skills in the environment where the skill is required. Through repetition and practice, in all phases the program, skill learning can be maximized. All staff are trained in the implementation of each client’s rehabilitation plan and apply the appropriate strategies and interventions to address cognitive, behavioral, psychological/emotional and physiological problems which are identified in the rehabilitation plan. Consistent with the NRI Intensive Neurobehavioral Rehabilitation model, the TLC and CLC programs offer each client multiple opportunities to practice skills.

 Crisis Management:

The TLC and CLC programs are designed to accommodate individuals with severe neurobehavioral problems. We anticipate that periodically an individual may experience behavioral exacerbations and require additional support. Individuals who require additional behavioral support and supervision may have these services made available either through their rehabilitation plan of care or on an “as needed” basis as periods of behavioral difficulties are encountered.

If an individual residing in the TLC or CLC requires a return to the NRI inpatient unit to provide additional behavioral intervention, a temporary return can usually be arranged. In the event bed space on the NRI inpatient unit is not available, special staffing arrangements can be made to provide additional services in the TLC or CLC.

Our goal for clients who experience a behavioral crisis is to provide them with the support they need to return to behavioral stability and to continue on in their rehabilitation program.

Staffing and Supervision:

The NRI Complex Care, Intensive Neurobehavioral and Brain Injury Dual Diagnosis Rehabilitation programs provides a consistent and highly structured treatment environment. While the patient care unit is located within a locked hospital, the program participants enjoy a wide range of therapeutic activities, including therapeutic services in community settings. The TLC clients participate in the NRI day program and receive ongoing rehabilitation and treatment services at Brookhaven Hospital on a daily basis. They will reside at the TLC and join the hospital-based program at the start of the treatment day and return to the residence in the late afternoon or early evening where they prepare a communal dinner and participate in a home based social skills reacquisition program.

The CLC clients will participate either in the NRI Day Rehabilitation program or in an individualized program of services based on their rehabilitation plan. Clients in the CLC program will receive staff supervision on a twenty-four-hour basis.

Medical Support Services:

Individuals participating in the Intensive Neurobehavioral Rehabilitation, TLC and CLC programs receive the supervision and support services available to all NRI clients. Each individual is assigned to an Attending Physician  with available services of an Internist or Psychiatrist as required. Nursing staff provide for health care supervision and medication oversight. Individuals in the TLC and CLC programs will receive early morning and late night medications, if required, from a Licensed Practical Nurse (LPN). Clinical program supervision is provided by the NRI Program Director. Case Management Services are provided by the Director of Case Management and Utilization Review. The Rehabilitation Team meets on a scheduled basis to review each individual’s program and to address any program modifications to support continued growth and positive change.

Program Fees:

The basic Program fees for the Intensive Neurobehavioral Rehabilitation, TLC and CLC programs are based on an all inclusive per diem charge, or if required, on a Fee-for-Service schedule. Physician fees, laboratory and pharmacy charges are usually included in Comprehensive Per Diem fee unless stated otherwise.

If additional services are required, the per diem charge will be augmented with an hourly or daily fee based on utilization.

Payer Sources:

NRI accepts patients from a variety of governmental (state and federal) insurance sources; commercial insurance; self-insured workplace health plans; Workers Compensation Insurance and private pay sources, including annuities or managed trusts and life estates. NRI has developed contracts with Medicaid and Medicaid Managed Care Organizations (MCO) in many states based on individual cases presented to the program. The hospital and its programs participate in the Medicare program.

 Licensing and Accreditation:

Brookhaven Hospital is licensed by the State of Oklahoma Department of Health. The hospital’s programs are accredited by the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO). The programs are certified by the Center for Medicare Services (CMS). The NRI programs are accredited by CARF under the Medical Rehabilitation and Residential Brain Injury Standards.

Hours of Operation and Admissions:

As part of Brookhaven Hospital, the NRI programs operate 24 hours per day, 365 days a year. Admissions to the programs must be scheduled in advance and a screening evaluation of the potential patient may occur in their current location or at the hospital. Many individuals are referred to the NRI programs due to crisis situations involving their care and placement. In those situations the NRI Team works with the person, their significant others, the referral sources, the funding agency and the person’s current placement to effect a smooth transition into the NRI program.

 

Neurologic Rehabilitation Institute at Brookhaven Hospital Fee Schedules

Attachment “A”

 

Inpatient Medical Rehabilitation Programs

Transitional Living Center (TLC) and Community Living Center (CLC) Programs

All program services rates are specified in the hospital’s Charge Master and Individual Contract Rates are developed with the payer source as needed by the hospital’s Contract Manager.