• Devereux Pennsylvania

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Community Living for Individuals with Brain Injury

Devereux PA Adult Services provides residential supports for individuals with brain injuries and other cognitive/neurological impairments which facilitates opportunities for participation in community living and meaningful daily activities with the needed supports and supervision to ensure the wellbeing of the individual.  

The goal of the Community Living Program for Individuals with Brain Injury (CLIBI) is to empower each person to discover their innate strengths, unique talents and their potential to live a meaningful and productive life. Our goal is accomplished by providing each person we serve with a customized plan of support that focuses on maximizing a person’s strengths and providing the therapeutic and daily supports to help increase the individual’s capacities of self-direction, self-management, and potential. Our comprehensive effort is guided by our Philosophy of Care is which is comprised of three fundamental principles: 

  • Positive Approaches - Finding a Positive way to work through each situation
  • Individualized Services - Every Person is Unique
  • Effective and Accountable Services - Using data to ensure positive outcomes
    CLIBI provides individuals the opportunity to live in a community setting with help and guidance in finding and retaining a job, finding a volunteer opportunity or a vocational program, learning how to arrange for public transportation, planning and arranging for participation in social and recreational activities, building friendships and relationships and developing a network of natural supports in the community. CLIBI are shared living arrangements in comfortably furnished apartments and homes, with community areas and individual bedrooms for the privacy of each person.

Program Objectives:

An Individual Support Plan (ISP) or Treatment Plan is developed for each person. This document is the result of Person Centered Planning that has usually taken place with the individual, a case manager from the funding agency, Devereux’s inter-disciplinary team, and the family/friends/guardian or interested parties. The Plan generally includes the following areas:

  1. Developing self-management and independent living skills by the use of desired and relevant outcomes. Outcomes are based on the following questions:      

  • Communication-can the individual communicate effectively? What supports/therapeutic interventions are needed to improved communication?

  • Relationships-does the individual have friends, family, intimate relationships? What can be done to help the individual to develop or improve relationships?

  • Recreation/Social Life- does this person have hobbies, faith based activities, club memberships?

  • Self-image and esteem-who in this person’s life makes him/her feel valued and important, what activities and groups or persons could help this person to feel valued and important? Does this person work, attend a vocational program or participate in volunteer activities?

  • Safety-does this person feel safe? Is the level of supports and supervision adequate for this person? Is the home, community, work or vocational program safe?

  • Healthy Living-does the individual have privacy, dignity and respect? Is the individual aware of their rights? Does the individual have adequate medical, dental and clinical care and supports?

  • Decision making and autonomy- Does the individual make decisions as to who they live with and what they do each day?

  • Active employment or work training abilities.

  1. Other areas of the ISP or Plan of Support include:

    • Individual preferences and interests

    • Transportation.

    • Medical and health information –current doctors, appointments, medication (dose, reason for medication) , diagnosis, history and current medical issues

    • Types of services and services provided –frequency, duration, costs

    • Satisfaction with services –Is the individual satisfied with their services? Did the individual participate in their plan? Do they agree with the plan?

    • Individual participated in their plan?

    • Back-up plans in case of emergency.

  • Other supportive services such as art, music, speech, occupation or physical therapy, cog rehab.  

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Program Costs, Referral and Funding Sources:

Referrals for the CLIBI often come directly from families, other providers, rehabilitation hospitals, attorneys, insurers, and public payers such as the Office of Long Term Living’s Support Coordination Agencies.

The CLIBI per diem rate is based on an individual’s needs for support, supervision and daily assistance.  Devereux accepts HCBS Waivers from Pennsylvania and other states, commercial insurance, and private funding. The per diem rate includes the following services.

  • All services as outlined in the Proposed Treatment Plan or as identified by the interdisciplinary treatment team.

  • Support, supervision and care up to twenty-four hours per day to maintain health, safety and well-being of the client.

  • Case management duties performed by a Program Specialist.  

  • Nursing oversight.

  • Activities of daily living.

  • Productive daily activity, based on an individualized treatment plan.

  • Organized leisure and recreational programs.

  • Assistance in obtaining and managing health and financial benefits.

  • Transportation to medical appointments, daily activities.

  • Behavioral Analyst or licensed psychologist.

  • Furniture –bedroom, shared areas, linens, towels.

  • Accessible living environment, if needed.

  • Assistance in locating and enrolling in day programs, finding employment or community habilitation activities.

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Consultative Services Available on a Fee for Service Basis:

•   Physical therapy.

•   Occupational therapy. 

•   Speech therapy.

•   Cognitive Rehabilitation Therapy.

•   Psychiatric services.

•   One-to-one supervision.

•   Supported employment coach.

Services Not Included in Per Diem:

  • Services/supplies not related to the brain injury.

  • Personal care attendant/One-to-one supervision.

  • Medications.

  • Laboratory Services/Diagnostic Services. 

  • Wheelchair rental/purchase.

  • Durable medical equipment.

  • For individuals receiving funding through a State HCBS Waiver- room and board is paid through a monthly “cost share” from the individual’s Social Security entitlement benefits.

  • Personal care/hygiene items.

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Admission and Discharge Criteria: 

Devereux has Admission and Discharge Polices-please refer to these Policies for more detailed information. Devereux’s CLIBI Admission criteria include:

  • Documented brain injury or other neurologic disorder.
  • Eighteen years of age or older.
  • Stable physical and mental health-not actively suicidal or engaging in substance abuse.
  • Ability to participate.
  • Completion of specialized rehabilitation.
  • Confirmation of funding.
  • Criminal Background Check documents which confirm that the individual does not have felony convictions or has been convicted with offenses under Megan’s Law (this will be reviewed on a case by case basis with consideration given to situational factors).  

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Discharge and Transfer Criteria Include:

An individual may be transferred or discharged from a Devereux home/program if his/her Interdisciplinary Team demonstrates that the current program cannot meet the needs of the individual. Reasons for discharge include:

  • An individual has met or is not making progress on their outcomes/goals and needs a less restrictive/more independent home or an individual requires a higher level of care than is currently provided in their program.

  • A change in the availability of funding, or a lack of funding for services which are critical for the individual’s well-being, health or safety. A negative balance in a Devereux Client Account for longer than 3 months.

  • An individual’s actions jeopardizes the safety or welfare of herself/himself or others, he/she may be transferred or discharged from their home/program. This may include fire-setting, sexual aggression, sexual promiscuity or attempts to engage in any type of sexual behaviors with children, active suicidal tendencies, substance abuse, explosive patterns of destruction or aggression, or psychotic behaviors.

  • An individual or family/guardian’s refusal to follow a course of treatment prescribed by the individual’s treating physician.

Discharge /Transfer Procedure:

At any time during an individual’s enrollment at Devereux Pennsylvania Adult Services, the Interdisciplinary team may recommend a transfer or discharge or the individual may have temporarily or permanently lost funding or funding eligibility.

The Director of Admissions will notify the individual, family, and/or agency of the possibility of discharge and will invite and encourage interested parties to participate in an interdisciplinary team meeting to discuss available options including discharge. Whenever possible, family and/or community integration is considered for future placements. Discharges can be made to settings such as residential treatment facilities, hospitals, nursing homes, to a family member, to an independent living arrangement in the community, or to a community-based program with staff supports.

The Admission Department will work with the Interdisciplinary Teams to transfer the individual to an appropriate program within Devereux, if available. If there is no home available to meet the needs of the individual, alternative placement will be sought within the Devereux Treatment Network. If these options are not available, discharge may occur outside of Devereux. Devereux will assist with placement and recommend other providers, whenever possible, however, it is the responsibility of the individual, family/guardian, and/or agency to arrange placement.

In situations regarding a loss of funding or eligibility for funding, the Admission Department will make every effort to reinstate funding eligibility or to secure funding from an alternate source. In most cases, if health and safety are not at risk for the individual or others, Devereux will continue to support an individual until another placement is identified.

Devereux will make every effort to provide 30-days written notice to an individual and their representatives; however, this is not always possible if there is an immediate risk to the safety and well-being of the individual or others, immediate discharge may be needed.

Non-Discrimination Policy

It is the policy of PA Adult Services to practice non-discrimination in services. All activities with regard to referrals, admissions, placement of individuals, and provision of services shall be conducted without regard to race, color, religious creed, ancestry, national origin, sex and sexual preferences.       

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