Medicaid Independence Plus May 9, 2002

1. A Demonstration Program for Family or Individual Directed Community Services Person-Centered Planning; Individual Budgets; Group Living No More Than 4 Persons; MedicaidIndependence PlusMay 9, 2002

2. Target Groups: NEW, first time ever listed on a Medicaid Waiver Form……………. Brain Injury (Acquired) Brain Injury (Trauma) Independence Plus, cont.

4. Age Distribution: Under 65 years - 8.5% 65-74 years - 12.3% 75-84 years - 32.8% 85 years and over - 45.9% Nursing Home Residents All families-1997Total: 1,608,700 Source: National Center for Health Statistics March 1, 2000

6. People With Brain Injury Are “Speaking Out” About Quality in Services National Center on Outcomes Resources (410) 583-0060 Info@the council.org Self Determination 2001

7. “I don’t want to feel that I am just getting the same prepackaged deal as everyone else. Make it about ME.” “My goals should be just that…MY choice.” “Before you ‘release’ me to the community, help me to build a support network.” Speaking Out

8. “I still have a vision for my future. Don’t take that from me. Rather, help me make it clearer.” “Invite me to the table where decisions are made about me. Welcome me and adapt my environment so that I can function at my maximum potential.” Speaking Out

9. “Please be honest about what you can and cannot offer me. If there are limits and caps, let’s negotiate priorities together. Take the time to know me as a person. Take the time to find out who I was before the accident. My self-esteem is tied to who I was yesterday and who I am today.” Speaking Out

10. “Quality of life is freedom and independence.” “Quality of life is having the opportunity to wake up in the morning with a purpose and the ability to pursue it.” “Quality of life is having the opportunity and tools to achieve my goals.” Speaking Out AboutQuality of Life

11. Rehabilitation of Persons with Traumatic Brain Injury NIH Consensus Development Conference, October 1998

12. Rehabilitation Services should be matched to the needs, strengths, and capacities of each person with TBI and modified as those needs change over time. Rehabilitation Programs for persons with moderate or severe TBI Should be interdisciplinary and comprehensive. NIH Panel Recommendations

13. Families and significant others provide support for many people with TBI. To do so effectively, they themselves should receive support. This can include in-home assistance from home health aides or personal care attendants, daytime and overnight respite care, and ongoing counseling. NIH Panel Recommendations-2

14. Rehabilitation efforts should include modifications of the individual’s home, social and work environments to enable fuller participation in all venues. NIH Recommendations-3

15. Community-based nonmedical services should be components of the extended care and rehabilitation available to persons with TBI. These include but are not necessarily limited to clubhouses for socialization, day programs and social skills development programs, supported living programs and NIH Recommendations-4

16. Independent living centers, supported employment programs, formal education programs at all levels, case manager programs to support practical life skill redevelopment and to help navigate through the public assistance and medical rehabilitative care systems, and consumer, peer support programs. NIH Recommendations-5

17. Medical “Model” VS Psychosocial “Model”

18. FROM A CONTINUUM OF CARE TO AN ARRAY OF INDIVIDUAL AND FAMILY SUPPORTS Brain Injury Association, Inc.

19. FREEDOM to plan a real life AUTHORITY to control a limited amount of resources SUPPORT for building a life in one’s community RESPONSIBILITY to give back to one’s community PRINCIPLES OF SELF DETERMINATION

20. Equality of Opportunity Full Participation Independent Living Economic Self Sufficiency Goals of the ADA

21. ADAIntegrationMandate“A public entity shall administer services, programs and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities” 28 CFR Section 35.130(d)

22. Belonging be-long, v. 1: to feel and be a part of …i.e. of a community, a workplace, a neighborhood or school 2: to enjoy a sense of contribution, value, self-worth 3: to truly believe one is a natural and equal part of the whole 4: comfortable, safe, cared for, welcome.

23. Housing Health Care and Appropriate Medical Services Mental Health/Behavioral Health Services Education/Higher Education Employment/Supported Employment Transportation A Successful Community Life

24. Assistive Technology and Devices Leisure and Recreational Activities Friends and Relationships; Support Circles Community Support Workers Customer Choice and Control System Infrastructure Quality Assurance Successful Community Life - 2

25. Assistive Technology Device Any item, piece of equipment or product system whether acquired commercially off the shelf, modified or customized that is used to increase, maintain or improve functional capabilities of individuals with disabilities.

26. Brain Injury Association of America Moss Rehabilitation Temple University University of Akron Spaulding Rehabilitation Assistive Technology and People with Cognitive Disabilities

27. Two-thirds of all fall-related TBI deaths occur among older adults One-half of all fall-related TBI hospitalizations occur among older adults Pacific Inst. For R&D, Unpub. Data, 1997 Falls and TBIAmong Older Adults Aged >65

28. Estimated total lifetime costs for fall related TBI’s were $3,300,000,000 ($3.3Billion) - Two-thirds of these costs were among those aged 75 and older The average lifetime cost per person was $180,000 Pacific Inst. For R&D, Unpub. Data, 1997 Costs of Fall-Related TBI’s inOlder US Adults Aged>65(1997)

29. Percentage of US Population Over 65 Years of Age Percentageof US population over 65 * projections

31. Senators Enzi and Mikulski To develop effective public education strategies carried out by the National Safety Council To expand needed services and conduct research in prevention and treatment To evaluate the costs to Medicare and Medicaid and potential for cost reduction Elder Fall Prevention Act of 2003S. 1217 June 9, 2003

32. Se Habla Espanol Family Helpline1-800-444-6443Over 17,000 calls in 2002

33. Centers for Disease Control & Prevention

34. Three year cooperative agreement $250,000 in year 1 Pilot in Mississippi and Wisconsin Opportunities to leverage private corporate dollars One universal 800 number widely advertised and disseminated; uniform data base; information and linkage to services National Information Center for Traumatic Brain Injury

36. Bancroft Neurohealth Casa Colina Centers for Rehabilitation Centre For Neuro Skills Gentiva Rehab Without walls Lakeview NeuroRehabilitation Centers Learning Services Corporation AACBIS Corporate Advisory Council

37. The May Institute, Inc. The Mentor ABI Group Rainbow Rehabilitation Centers Inc. ReMed Robert Voogt & Associates AACBIS Corporate Advisory Council (cont.)

38. Vision Statement A world where all preventable brain injuries are prevented, all unpreventable brain injuries are minimized and all individuals who have experienced brain injury maximize their quality of life