The magic of 18 is more than a coming of age event for a young person with a brain injury living in a residential care facility. That birthday may signal placement in a skilled nursing facility filled with older adults, isolating them from peers, school, family and the community. Young people with severe disabilities resulting from traumatic brain injury may require a level of care which can only be funded in a nursing home facility based on the current restrictions in funding. At this point there are few other options available for a growing number of young people who face a lifetime of disability and require significant physical care.
The odds favor survival for young people involved in serious accidents and medical advancements are allowing more individuals to survive. Unfortunately, the options for placement other than home are limited to facilities where there may be few other young adults and little in the way of programs and services which can sustain progress. A far cry from the school programs and pediatric facilities designed to serve young people with disabilities.
There is a need for specialized facilities and programs which can serve young people with severe disabilities from brain injury. These places don’t have to be nursing homes and, in fact, other care environments may enhance independence and community participation and add to a quality of life. In order to create alternatives we need to revise the restrictions placed by Medicare and Medicaid. Some states have implemented brain injury waiver programs to support home, community and specialized services and have fostered the development of effective alternatives. A story in the New York Times of May 15, 2008 addresses the needs of people with severe disabilities who are turning 18 and frames out the issues.