On With Life: Residential Neuro Rehabilitation Overview
Traumatic brain injury (TBI) is defined as an injury that results from a violent blow or jolt to the head or body. An object that penetrates the brain tissues, such as a bullet or shattered piece of skull can also cause a TBI. Mild injuries can temporarily affect your brain cells while more serious injuries can result in bruising of the brain, torn tissues, bleeding and other physical damages that can lead to long term complications or even death. For many families, living with the impact of TBI is a hard reality. Twenty- seven years ago in Ankeny, Iowa, a group of brain injury survivors and their families made their dream a reality by opening On With Life. After struggling with the reality of living with the aftermath of brain injury, the families envisioned opening a rehabilitation facility that would provide services to persons living with brain injuries. Since 1991, the organization has helped over 4,000 families and has continued to expand each and every day. Early this year, On With Life expanded again, opening the Residential Neuro Rehabilitation (RNR) house.
Mission, Goal, & Funding
The RNR house is located in Highland Park in Des Moines, Iowa and consists of five bedrooms and four bathrooms. The mission of the RNR is: “joining hands, hearts, and minds to help persons living with brain injury get On With Life". The goal of the RNR is to help persons living with brain injury to become more independent in a home setting rather than in the inpatient setting.
Funding for the RNR house comes from either private or state funded insurance companies that pay for the care that the persons served receive.
Staffing and population served
The population of the RNR house consists of five individuals that are suffering from brain injuries. Some of the population also includes persons who are suffering from a brain injury who have a psych component to their injury as well (For example, Bi-polar disorder, depression, etc.) The house however, will not accept persons with only a psych disorder, as they would not meet admission criteria. Staffing at the RNR house looks a little different then it would in the traditional healthcare setting. In a typical day, there are 3 Residential Support Professionals (RSP) who are responsible for assisting the persons served in meeting their goals of independence by encouraging and assisting them in completion of activities of daily living (ADLs). Each day there is also a team lead in the house who is responsible for overseeing the overall functioning of the house and are also responsible for supervising the RSP staff. The manager of the RNR house overlooks both the RSPs and the team lead and is present at the house on an as needed basis. Although only on campus part of the time, the manager position is still considered full time. Outside of the house the manager is responsible for implementing policies and procedures as they relate to the functioning of the house and for hiring new staff members as needed. During each shift there is also a registered nurse on staff that is responsible for overseeing the medical needs of each of the persons served. The position is considered part time and is on an as needed basis depending on the medical needs of each of the persons served that are currently staying in the house. The RN on staff is also responsible for implementing the policies and procedures as they relate to the medical needs of the persons served.
Services Provided & Cost to the individual
Residential Neuro Rehabilitation is a subservice to the inpatient side of On With Life located in Ankeny, Iowa. Services provided within the RNR house include help with ADL’s, transportation to and from outpatient rehabilitation at the main campus. The RNR house is designed to take in persons served that are transitioning from the inpatient side of rehabilitation that are not quite ready to return home. A large advantage of the RNR house is that it is small enough that care for each persons served can be individually tailored to meet needs that are specific to each person’s personal setting at home. When each person arrives to the house, they meet with a team of staff and develop goals that are important for them to achieve before they return home.
Another risk to the organization could include competing with other facilities for referrals from insurance companies. A large chunk of the funding for the RNR house comes from payments from insurance providers. If the insurance companies are not aware of the RNR house they may not refer their clients to the house, meaning that funding would be cut off. Another part of the funding for the RNR house comes from the payments made by each of the individuals living in the home. The specific costs to each individual are minimal. Each person’s family income is taken into consideration and then expenses and 100 dollars for personal needs are taken out monthly equally the cost of services obtained.
Risks to the organization
As with any setting in healthcare, there are risks to this type of organization as well. Cristina Garcia, a registered nurse working at the RNR house, stated that the need for the level of care and services provided by the staff never ceases and that having limited beds available is their biggest risk.
Although the care received by the facility is immense, due to the limited beds, people affected by brain injury are either put on a waiting list or forced to look for a different facility such as Neuro Restorative or Community Neuro Rehab that offer a larger amount of beds, but maybe not the same high level of care offered by the specialists at On With Life, meaning that their care may suffer as well.
Measurement of Outcomes
In order to ensure that care is effective, the team at the RNR house meets quarterly (or more often as indicated by insurance) with the families and persons served to determine whether or not their goals are being met. As stated earlier, when a persons served arrives to the house, they sit down with their families and the team to produce written goals. During each meeting the goals are discussed and re-evaluated to see whether they have been met, are stagnant, or need to be changed to better meet the ongoing needs of the persons served. Because care is tailored to each individual specifically, it is not always easy for the organization to neatly put outcomes down on paper as compared to outcomes measured by other facilities like hospitals.
Nursing Impact
Nursing can have a very large impact on the persons served that come to the RNR house. Even though there is only an actual nursing member on site part of the time, there is still a lot that they can help the persons served accomplish. The RSP staff members act as a Certified Nursing Assistant (CNA) for the persons served, helping them with ADLs and using the restroom, eating, etc. Although they are not certified to specifically do the same tasks that a CNA in a typical healthcare setting would, they are always on site and are a great asset to the home. When the RN is able to be on site they are responsible for administering the medications that allow persons served to be pain free while partaking in their rehabilitation activities. While in house, the RN is responsible for providing education to the persons served and their families on their disease process and how best they may be able to manage it when they return home.
Relationship to course concepts
There are many ways that the treatment and care that takes place at the RNR house can be applied to the concepts that we are learning in class this semester, but to me the two that seemed to be the most fitting included mobility and grief/loss. It takes months, sometimes years, to recover from a brain injury that likely only took seconds to obtain. At the RNR house, the staff is committed to helping the persons served regain their independence by assisting them with daily cares each day and helping them work towards the goals that they set for themselves. Many of the people that come into the RNR house have left the inpatient side of rehabilitation and are likely months out from their initial diagnosis, it is the goal of that staff at the RNR house to get them closer to their end goal of being able to go home without the need for any further assistance or therapies. I also related the RNR hosue to the concept of Grief and Loss because a brain injury can take a lot away from a person. Not only can they physically be affected by the loss of movement in their limbs, but they can be, and most often are, affected emotionally as well. Part of the grieving process is to accept what has happened and to push forward to work towards achieving your goals. At the RNR house, the staff members push the persons served to go above and beyond their goals, to show them that they are not what happened to them, but instead they are what they choose to become.
Through hard work and understanding, the staff at the RNR house are able to individualize care for each person served and help them to work through their own personal struggles.
