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Michigan’s Long Term Care Conference

Michigan’s Long Term Care Conference. Michigan Model of Services for Person with Traumatic Brain Injury (TBI) and Their Families. March 23 & 24, 2006 Troy, MI. PRESENTERS ARE:. Robert Piccirelli, Parent of a survivor.

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Michigan’s Long Term Care Conference

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  1. Michigan’s Long Term Care Conference Michigan Model of Services for Person with Traumatic Brain Injury (TBI) and Their Families. March 23 & 24, 2006 Troy, MI

  2. PRESENTERS ARE: Robert Piccirelli,Parent of a survivor. Michael F. Dabbs,President, Brain Injury Association of Michigan, and Chair of the DCH TBI Services and Prevention Council. Manfred Tatzmann,Director, DCH State TBI Project

  3. What is a brain injury? Defining the background for this presentation.

  4. Brain Injury Definitions A brain injury is any injury that results in brain cell death and loss of function. Traumatic Brain Injury(TBI) is caused by an external trauma to the head or violent movement of the head, such as from a fall, car crash or being shaken. TBI may or may not be combined with loss of consciousness, an open wound or skull fracture (Thurman et al., 1994). Acquired Brain Injury(ABI) is an injury to the brain that has occurred after birth and includes: TBI, stroke, near suffocation, infections in the brain, etc. (Brain Injury Association of America, 1997). The term does not apply to brain injuries that are congenital or degenerative, or brain injuries induced by birth trauma.

  5. Brain can bounce against inside of skull & cause damage & tear. Smashes against BACK of skull. Smashes against FRONTof skull. Penetrating Wounds, I.e. bullet.

  6. A new type of brain injury These days there is a new category of injury – BLAST INJURY – A significant number of soldiers returning from the conflicts in Iraq and Afghanistan have this injury and will suffer long term consequences.

  7. First up - Bob Piccirelli

  8. CARE OF A PERSON WITH SERIOUS TBI • Some serious TBI occurs in hospitals and may require surgical removal of brain tissue. • Medical and rehab services are very complex and are required over a long time. • Improvements in functioning may continue to occur but very slowly over many years. • Obtaining support and care for non-insured, no-income persons has been very difficult in Michigan.

  9. TIMELINE • First seizures………………………………..1995 • St. John in-patient fall…………..1/8/1998 • Macomb Hospital……………………3/5/1998 • Bridgeway Home………………….8/11/1998 • Lawsuit settlement………………4/23/2002 • Special Tree Home…………………2/3/2003 • Natural Freedom Home…………9/2/2003 • His house……………………………….6/4/2005

  10. Medical Care Fall caused many hematomas; life and death decisions based on minimal information. Surgery, induced coma, pressure buildup, tracheotomy, feeding tube, deep bedsores. Seizures, medication adjustments, pneumonia, congestive heart failure. Intensive therapy (in-hospital, Special Tree), Baclofen pump implant, Baclofen withdrawal. Continued therapy and slow improvement 8 years post.

  11. Placement and Services Unusual: entering Medicaid system 4 years post; no discharge social worker; initially approached Oakland but shunted to Wayne. No FIA residential, CMH says ok, but eligibility denied; appeals made and legal costs incurred; very stressful delay; nursing home is only possibility. MOU obtained via fortuitous contact at DCH; great progress made even 5 years post; then again nursing home only possibility. Qualified for MI Choice; room and board from SSDI. Purchased home using settlement; MI Choice continues, some therapy via Medicare; incremental progress still being made.

  12. SUGGESTIONS: Re Single Point of Entry Maximum information to person and caregivers. Include “hand-holding” to access services and information. Specially trained, high-ability intake workers. A central as well as regional offices. Computerized and web-based to the public as well as workers.

  13. SUGGESTIONS: Re Documented Plan for person with TBI Planning team staffed appropriately for the person. Services, treatments and tests both wanted and possible/obtainable stated. Documented, computerized, web accessible. Documentation of what works and what does not. Structured so agencies can aggregate info for statistical analysis without violating privacy. Costs attributable to person documented.

  14. Why should TBI be a Long Term Care Concern? Mike Dabbs

  15. TBI in the United States What are the trends? Severe TBI Hospitalization and Death Rates, by Year, United States, 1980 – 1996 Data: National Center for Health Statistics

  16. TBI in the United StatesWhat are the costs? Estimated annual lifetime costs totaled $60 billion for the year 2000 Finkelstein E, Corso P, Miller T and Associates. The Incidence and Economic Burden of Injuries. New York: Oxford University Press, 2006.

  17. $60 billion is equal to

  18. How does TBI affect health? From one to three years post-injury, compared with the general population, people with TBI are: 1.8 times as likely to report binge drinking • 11 times as likely to develop epilepsy • 7.5 times as likely to die. From the SC TBI Follow-up Registry http://sctbifr.musc.edu/contact.html

  19. Michigan’s TBI Dilemma! • Medical model • Problem of diagnosis • Not consumer driven • No single point of entry • Fragmented provider system • Private resources not well used • Dual funding system creates confusion • Inefficiencies rampant among public agencies • Result in: • Consumer dissatisfaction, system frustration & high Medicaid cost!

  20. DHS TBI affects ALL Human Services! OSA MDE CMH’s Sub Abuse Medicaid, LTC, Waivers DOC Adult Svcs, Home Help, Children Services Jails, Law Enforcement Spec Ed, Students, Teachers VRS Rehab Services Hospitals Health Professionals

  21. Study Findings of the Long Term Outcomes After TBI A Study of 243 individual, controlled for age, gender, and severity of injury showed that: Increasing years post injury was associated with declines in physical and cognitive functioning, declines in societal participation, and increased contractures. Gale Whitenech Ph.D; Melissa Sendroy-Terrill, MA; Joseph Coll, Ph.D.; C.A. Brooks, MSHA, Craig Hospital, Engelwood, CO; University of Colorado Health Sciences Center, Denver, Co. 2006

  22. Proportion of People Reporting Problematic Outcomes 1 Year After Injury – Comparison of Two Age Groups* *Population Based Estimated Outcomes After Hospitalization for TBI in Colorado, Arch Phys Med Rehab, vol 85, Suppl 2, April 2004

  23. TBI COST TO THE MICHIGAN MEDICAID SYSTEM FOR Fee For Services = 1999-2002

  24. The TBI Team: A Partnership Lead Agency: Michigan Department of Community Health - DCH • Partners: • Brain Injury Association of Michigan • Mental Health & Substance Abuse Services – DCH • Public Health Administration – DCH – Injury Prevention & Epidemiology • Medical Services Administration (Medicaid) – Long Term Care • Department of Human Services - Adult Services & Field Services • Michigan Department of Education – Special Education

  25. This partnership approach needs to include and be incorporated into Michigan’s Long Term Care Office and Commission. TBI services and supports need to be an essential part of LTC efforts in Michigan!

  26. Manfred Tatzmann How extensive is the problem in Michigan?

  27. Major Causes of TBI in Michigan Motor Vehicle – cars, motorcycle, recreational vehicles. Violence – substance abuse related, domestic, and shaken baby syndrome. Falls – primarily among elderly and children.

  28. TBI Cases by Age and Severity

  29. TBI in the United States TBI Rates by Age Group* * Average annual rates, 1995-2001 Langlois et al., TBI in the United States, CDC 2004.

  30. Rates of Fatal and Nonfatal, Hospitalized TBI by Age and Sex Note: Rates are per 100,000 population in specified group.

  31. TBI Cost Information by Provider CategoryMichigan Medicaid-FFS 1999-2002 Between 1999 and 2002, Michigan Medicaid-FFS paid out about$11 million annuallyfor claims in which TBI was the primary or secondary diagnosis. Cost information is only presented for individuals enrolled in Fee for Service Medicaid since MHP files contain administrative data only. For this and other reasons, cost estimates presented in this section should be considered an underestimate of the TBI-related costs to Michigan’s public service system. Other reasons include the fact that only those cases with a TBI diagnosis are included, leaving out many costs in which the TBI was not recorded as a diagnosis on the claim. And of course, only direct Medicaid charges are summarized, leaving out the cost of service provision by CMHSPs, public schools, and MRS among others.

  32. Progress to Date • Produced Michigan Resource Guide (MRG) to educate & inform family members and professionals about TBI – 10,000 copies distributed – incl. Arabic & Spanish versions. • Created TBI website,www.michigan.gov/tbi • Developed40,000 brochuresfor public distribution. • Conducting extensivedata researchon incidence & prevalence. • Set up threepilot trainingareas – UP, SW MI, WCHO. • DevelopedTraining Manual,Access Guidelines • DevelopingWeb-based TBI training for professionals. • Completed and distributedFINAL REPORTin October 2004.

  33. State TBI Services and Prevention Council • In April 2005, MDCH Director, Janet Olszewski, appointed the first ever statewide TBI Council, composed of 27 member. • Representative of survivors, family members, advocates, providers, professional, and State agency partners. • Has four subcommittees to implement Final Report recommendations.

  34. Moving Forward With: • Completion of the Web-Training. • Developing a TBI Medicaid Waiver • Survey of survivors • Continuation of data gathering • Conducting outreach to stakeholders. • Working with Office of LTC and Single Points of Entry (SPE’s).

  35. GOAL! • To develop a seamless systems of care for person with traumatic brain injury that provides them with care and support according to their needs and condition – not source of payment!

  36. CONTACTS Michael Dabbs, President Brain Injury Association of Michigan 8619 W. Grand River Avenue, Suite 1 Brighton, MI 48116-2334 PH: (810) 229-5880 E-Mail:mdabbs@biami.org

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