The Virginia Department for Aging and Rehabilitative Services

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Meeting Minutes

Virginia Brain Injury Council

July 30, 2004
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Virginia Brain Injury Council Meeting Minutes

July 30, 2004

Present:

Paul Aravich, Eastern Virginia Medical School
Paul Blais
Tom Dashiell
Robert Demichelis, Brain Injury Association of America
Sandy Dyche
Patti Goodall, Dept. of Rehabilitative Services
Anne McDonnell, Brain Injury Association of Virginia
Julie Moon, R.N., Dept. of Education
Russell Payne, Dept. of Mental Health, Mental Retardation, & Substance Abuse Services
Fran Rooker, The Jason Foundation
Harry Weinstock, Brain Injury Association of Virginia
Pat Wilkins, Greater Harrisonburg & Shenandoah Valley Support Group / BIAV

Absent:
Donna Broshek, Ph.D., UVA Medical Center
Nancy Bullock, R.N., Dept. of Health / Maternal and Child Services
Catherine Harrison, Dept. of Medical Assistance Services
Jennifer Kraft
Joanne Mancuso, Commonwealth Support Systems
Christian Rubio-Cespedes
Wallace Satchell, McGuire Veterans Affairs Medical Center
Heather Sitterding, Department of Health
Antoinette Smith, Dept. of Rehabilitative Services
Cynthia Smith, Dept. of Mental Health, Mental Retardation and Substance Abuse Services
Susan Smith, Dept. for the Blind and Visually Impaired
Carolyn Turner, Dept. of Rehabilitative Services
Cathy Walker Department of Social Services
David Walsh, TBI Family Services
Laura Taylor, Ph.D., VCU Medical Center
Nathan Zasler, M.D., Concussion Care Centre

Guests:
Helen Butler, Brain Injury Services of Southwest Virginia
Keith Burt, Brain Injury Association of Virginia (Fishersville)
Kristie Chamberlain, DRS Commonwealth Neurotrauma Initiative Trust Fund
Connie Coogle, Virginia Commonwealth University
Marylin Copeland, Brain Injury Association of Virginia (Virginia Beach)
Tony Gentry, Virginia Commonwealth University
Carter Harrison, Alzheimer’s Assocoiation
Lorraine Justice, Brain Injury Association of Virginia
Karen Tefelski, VAACSSES
Patty Thompson, TBI Rehab, Inc.


The meeting was called to order at 1:15 p.m. by Karen Brown, Chair. New members were welcomed to the Council, followed by member introductions.


OVERVIEW OF COUNCIL HISTORY
Patti Goodall distributed a brief handout on the history of the Virginia Brain Injury Council (VBIC). Patti stated that VBIC was established at the direction of a former Secretary of the Virginia Office of Health and Human Services, Eva Teig in the late 1980s. Ms. Teig directed that the Department of Rehabilitative Services establish the Council in response to a report submitted to then-Secretary Fisher on the needs of Virginians with physical and sensory disabilities, including brain injury. (Interested members may request a copy of the original report from Patti.) Karen stated that the Council exists to advocate for the needs of people with brain injuries in Virginia by seeking to develop services and by promoting systems change. The Council also serves as an advisory body to the Department of Rehabilitative Services and other policymakers, and also serves as the advisory committee for Virginia’s federal TBI Act grant.

PUBLIC COMMENT
Karen announced the public comment period. Tony Gentry stated he is an Occupational Therapist who is currently working on a CNI grant looking at the benefits of the use of personal digital organizers by people with cognitive impairments. He commented that during his 18 years working with brain injured individuals he has observed a continual erosion of transition services provided to patients emerging from coma and in agitated states. He has seen neurobehavioral units throughout Virginia close and patients relocated out of the state to obtain these services. The lack of neurobehavioral units in Virginia places undue financial stress on the patient and his/her family and is contrary to the goal of reintegrating survivors into their communities.

APPROVAL OF MINUTES
Karen asked members to review the April 23, 2004 meeting minutes for approval. Fran noted an omission from the minutes regarding a tabled discussion of a potential board nominee. Following discussion, Karen suggested the board not approve the April minutes until revisions are made. Robert Demichelis made the motion that revised minutes be presented at the next Council meeting. Anne McDonnell seconded. Motion carried.

Action Item: April 23, 2004 Council minutes will be revised and presented at the next meeting for approval.

PRESENTATION / DISCUSSION /ACTION PLAN:
Development of Neurobehavioral Treatment Options in Virginia

Patti commented that Jim Rothrock, DRS Commissioner, suggested that Council members work with representatives from the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) to develop a “white paper” on neurobehavioral treatment options in Virginia as a basis for discussion/action between the commissioners of both agencies.

Patti provided a brief overview of a study done by DRS in the early 1990s that proposed to establish a secure neurobehavioral treatment unit at Woodrow Wilson Rehabilitation Center (WWRC) in Fishersville for people with brain injury and challenging behaviors. [The cost was estimated to be approximately $4 million over a two year period. The General Assembly appropriated $175,000 which is used to provide assistance to individuals being discharged from WWRC to their home communities.] Patti then pointed out the ongoing lack of short and long-term residential neurobehavioral options for people with brain injury and challenging behaviors. Current facilities in Virginia include Tree of Life in Glen Allen; Learning Services outside of Charlottesville; Virginia Beach Healthcare and Rehabilitation (a specialized unit of the nursing facility); Cardinal House (assisted living / nursing facility) in Waynesboro; and Lighthouse in Virginia Beach. Two major barriers include availability of space and cost.

Russell Payne of DMHMRSAS presented statistics on a statewide discharge assistance program (DAP) administered through his agency. He stated DAP was allocated $12 million for fiscal year (FY) 2004 which was increased to $17.4 million for FY 2005. DAP served 363 statewide, 35 of whom had an Acquired Brain Injury (ABI). Of the 35 ABI patients, 23 are served in a long-term residential environment, 2 were placed in a nursing home, 1 died prior to placement, and 4 are with their primary caretakers. He was unsure as to what happened to the remainder. The average cost of placement for the 363 non-ABI patients was approximately $37,000 per year, whereas the average cost for the ABI patient is almost $80,000 per year. These costs were compared to the stated average cost of Medicaid reimbursed nursing home care ($30-35,000 per year) and the average cost of inmate housing for the Department of Corrections ($50,000). Re-hospitalization for the ABI patient is about 1%. Russell further commented that new funding is targeted toward mental health patients who are clinically ready for, but have barriers to, discharge. This population is estimated to be 100 patients per month, 1% of whom have an ABI.

Patti brought up the issue of the mental health facilities intentionally screening out people with a “primary diagnosis” of brain injury. Fran Rooker also commented on substance abuse programs offered through local Community S