Traumatic Brain Injury: Spectrum of Services

Acute Rehabilitation

Acute rehabilitation is often needed after a brain injury to work on improving skills related to physical health, personal care, cognitive processing, language and communication, movement and mobility, behavior, environmental awareness and responsiveness.

Sub-Acute Rehabilitation

Sub-acute rehabilitation addresses other issues, such as community living, behavior and emotions, employment, school, recreation, and living independently.

Counseling/Behavioral Services

Counseling/Behavioral Services assist with the emotional and behavioral issues that can arise with brain injury. After brain injury, most people go through a period of emotional recovery. The person with the injury, his/her family and loved ones may need to process how their lives have been affected by changes, such as those related to abilities, personality, employment, vocation, interests in hobbies, recreation or athletic activities, and family structure and support. A sense of loss is common. Counseling and behavioral services can help the persons with the injury and their family throughout this time and beyond. Many types of professionals deal with the emotional and mental health issues related to brain injury. The following is a list (in alphabetical order) of the types of professionals in the counseling field:

  • Behavioral Analysts
  • Family and Marriage Counselors
  • Licensed Clinical Social Workers
  • Neuropsychologists
  • Psychologists
  • Psychiatrists
  • Religious Leaders

Home Care Services

Home care services can play an important role in helping persons with brain injury to live within the least restricted setting. These services can include:

  1. Skilled nursing services provided by a licensed nurse on an intermittent or part time basis.
  2. Private Duty Nursing provided by registered or licensed practical nurses to persons in need of more continuous nursing care than an intermittent basis.
  3. Home Health Aide services provided by a certified home health aide to help with meal preparation, dressing, bathing, grooming, medication administration, and/or incidental homemaking services.
  4. Personal Care services provided by a non-licensed personal care aide and are non-medical in nature and include independent living services.
  5. Therapies provided by therapists licensed in each of the following capacity: physical, occupational, respiratory and speech therapy.

Independent Living Skills Training

Independent living skills training may be needed for the person with brain injury to enable him/her to live on his/her own, such as being able to manage money, take care of grooming and personal hygiene, prepare meals, do laundry, etc. These tasks are often referred to as "activities of daily living" or ADLs. Many people with brain injury live independently and can take care of their daily needs. Others need help with ADLs and/or instruction on how to regain those skills again after a brain injury. Some providers assist and teach the person with brain injury in the person's residence while others provide the service in an office or other setting. ILST services are provided to help the person with brain injury become as independent as possible.


Housing is a basic need for all individuals and may need to be modified for persons who sustain a brain injury. After a brain injury, a person can experience difficulty with judgment, behavior, memory, confusion, or other characteristics that can lead to an unsafe living environment. Persons may not be able to be independent in safely cooking, using electrical equipment, answering the door, telephone, etc. In addition, access to alcohol, medications, car keys, etc. may need to be limited for safety reasons.

The following is a descriptive list of housing services/options available for persons with TBI in New York State:

  • Living with Family is a common option, although modifications to the home or apartment may sometimes be needed. For example, a person with brain injury may need handrails or grips installed in the bathroom and along steps, furniture rearranged for ease in getting around, a ramp entry into the home, and other alterations. Possible funding sources for home/apartment alterations for persons with brain injury may be found at New York Connects, Choices for Long Term Care.
  • Renting is an option for people who can live independently but are not interested or able to perform home maintenance. Information about possible rent subsidies or assistance may be obtained through New York State Homes and Community Renewal.
  • Assisted Living Residences are adult homes or enriched housing programs certified by the State Health Department. An operator of an Assisted Living Residence is required to provide or arrange for housing, 24-hour, on-site monitoring, and personal care services and/or home care services in a home-like setting for five or more adult residents. Assisted Living Residences must also provide daily meals and snacks and case management services, and is required to develop an individualized service plan. The law also provides important consumer protections for people who reside in Assisted Living Residences.

    Assisted Living Residencess may offer each resident his/her own room, a small apartment, or a shared space with a suitable roommate. Residents will share common areas, such as the dining room or living room, with other people who may also require assistance with meals, personal care and/or home care services. Assisted living residences help individuals to live as independently as possible.

  • Enhanced Assisted Living Residences are certified to offer an enhanced level of care to serve people who wish to remain in the residence as they have age-related difficulties beyond what a basic Assisted Living Residence can provide. To enter an Enhanced Assisted Living Residence, a person can "age in place" in a basic Assisted Living Residence or enter directly from the community or another setting. If the goal is to "age-in place," it is important to ask how many beds are certified as enhanced and how your future needs will be met. People in an Enhanced Assisted Living Residences may require assistance to get out of a chair, need the assistance of another to walk or use stairs, need assistance with medical equipment, and/or need assistance to manage chronic urinary or bowel incontinence.
  • Special Needs Assisted Living Residences are certified to serve people with special needs, for example Alzheimer's disease or other types of dementia. Special Needs Assisted Living Residences have submitted plans for specialized services, environmental features, and staffing levels that have been approved by the New York State Department of Health.

    The services offered by these homes are tailored to the unique needs of the people they serve. Sometimes people with dementia may not need the more specialized services required in a Special Needs Assisted Living Residence, however, if the degree of dementia requires that the person be in a secured environment, or services must be highly specialized to address his/her needs, he/she may need the services and environmental features only available in a Special Needs Assisted Living Residence. The individual's physician and/or representative and Assisted Living Residences staff can help the person decide the right level of services.

  • Senior Housing In recent years, the choice in housing alternatives for seniors has grown because of an increasing number of elders seeking living environments that match their needs and preferences. Information about senior housing options available in New York State may be obtained from the New York Connects, Choices for Long Term Care website.
  • Adult Care Facilities are regulated by the Department of Health and may be operated by for profit or not for profit entities. Further information about these options may be obtained at New York State Adult Care Facilities. The following two housing options are a type of Adult Care Facility.
    • Adult Homes provide long-term residential care, room, board, housekeeping, personal care and supervision for five or more adults unrelated to the operator and tend to be characterized as either single-or double-occupancy with congregate dining and activity areas.
    • Enriched Housing Program is a type of adult home that provides long term residential care including room, board, housekeeping, personal care and supervision to five or more adults, primarily persons 65 years of age or older, in community integrated settings resembling independent housing units and are generally an apartment-based model.
  • Long Term Care refers to a range of supportive medical, personal and social services needed by people who are unable to meet their basic living needs for an extended period of time. The service needs may include household cleaning, meal preparation, shopping, paying bills, visiting the doctor, etc. Visit the New York State Long Term Care website for detailed information.
  • Nursing Homes or Skilled Nursing Facilities are regulated by the New York State Department of Health and provide the highest level of 24-hour institutional care to persons who cannot meet their basic living needs for an extended time. For information about these facilities go to New York State Long Term Care website.

Questions to Ask Providers of Service

When looking for professionals that provide services to persons with brain injury, it is suggested that you do your research to assure they are competent before making a selection. You may want to interview two or more professionals before choosing the best one for your situation. The following list of questions can help get you started. You may want to ask more questions given your particular situation.

  1. How long have you been providing services to people with brain injuries?
  2. How many persons with brain injuries with situations similar to mine have you provided services for?
  3. What education or training do you have that makes you qualified to provide services to persons with brain injuries?
  4. How can we work together to encourage independent living for myself (or my loved one)?

Questions to Ask Providers of Housing

Try to find two or three housing providers to tour and interview. Pay attention to cleanliness, safety, security and overall atmosphere. Notice the manner in which staff members interact with residents.

  1. What are the fees and what do they cover? Are there additional expenses?
  2. How is the program paid (private pay, insurance, governmental assistance)?
  3. Are bedrooms and bathrooms private or shared?
  4. What is a typical daily schedule for residents?
  5. What meals are provided? Do residents help with meal preparation?
  6. How is communication with the family fostered?
  7. Is independence encouraged and supported?
  8. Can services be adapted when the person demonstrates either an increase or decrease in functioning?
  9. How are physical, medical, and behavioral challenges handled?
  10. What is the staff to resident ratio? What is the turnover rate of staff?
  11. What are the qualifications of staff and their ongoing training requirements?
Resources for Brain Injuries
Type of Help Contact Name Contact Information
Advocacy/Help Information Education/Vocation Support Groups Brain Injury Association of New York State 800-444-6443 or 518-459-7911
Information for the Public, Doctors, Nurses, Parents, School Officials, Students, Athletes, Coaches, etc. Centers for Disease Control & Prevention 800-232-4636
Information, General National Institutes of Neurological Disorders and Stroke 800-352-9424 or 301-496-5751
Information, Caregiving Brain Line 703-998-2020 or Email
Home and Community Based Services for seniors and persons with disabilities
New York State Office for the Aging Aging, 800-342-9871
New York Connects Local Connects Contacts
Home and Community Based Services for eligible persons 18 to 64 with TBI New York State Department of Health 800-541-2831 (Medicaid), 800-633-4227 (Medicare)
Medicaid Waiver for eligible persons who sustain a TBI between the ages of 18 & 64. New York State Department of Health Medicaid Waiver information booklet, contains local contact numbers
Home and Community Based Services for persons who sustain a TBI prior to age 22 Office for People with Developmental Disabilities 866-946 9733
Substance/Alcohol Abuse (may co-exist prior to or after a brain injury) New York State Office of Alcohol & Substance Abuse Services 877-846-7369 or Provider Directory Search
New York State Division of Veterans Affairs 888-838-7697
Defense and Veterans Brain Injury Center 866-966-1020
Victims of Crime Assistance New York State Office of Victim Services 800-247-8035
Vocation Assistance New York State Adult Career & Continuing Education Services, Vocational Rehabilitation 800-222-5627