CONSIDERATIONS IN THE PURCHASE OF POST-ACUTE REHABILITATIVE SERVICES FOR THE HEAD INJURED

Rehabilitation for the traumatically brain-injured patient has undergone tremendous growth and change in the last ten years. Innovative treatment techniques and treatment environments have developed, outpacing the consumer’s ability to monitor efficacy. This paper provides discussion of numerous parameters which may impact the operation and efficacy of post-acute rehabilitation programs for the traumatically brain-injured patient. In the last ten years, medicine has seen the introduction of many changes. While some of the more acknowledged and visible changes have occurred as a result of Medicare reform of 1983 (i.e., Diagnosis Related Groups), equally significant changes have seemingly occurred in response to the demands of a new population. In 1977, there existed few treatment facilities in the country dedicated specifically to the rehabilitation of traumatically brain-injured patients. Certainly, treatment was available from general rehabilitation units in acute care hospitals; however, these units did not focus on the special needs of this population. Treatment models were often designed after a cerebral vascular accident (stroke) model and were thus plagued with inadequacies. Professionals attempted to treat diffuse neurological injuries and their sequelae via a system originally designed to treat comparatively focal neurological insults and resultant physiological deficits. Conventional wisdom held that maximal recovery following neurological insult was complete somewhere between six and twelve months following onset. Families, patients and treating professionals alike operated with these expectations. Patients were therefore discharged to family settings, nursing homes, or locked psychiatric facilities for lack of more appropriate settings.