Program Description

Mission Statement

Our mission is to develop and administer programs to enhance the safety and quality of life for individuals who have sustained a traumatic brain injury, through a quality, comprehensive continuum of care. We provide a variety of supportive services to assist the individual the skills needed to help them live as independently as possible.

Scope of Care

We provide a comprehensive range of specialized residential and outpatient rehabilitative services to people recovering from brain injury, spinal cord injury, severe orthopedic injury and limb loss, neurological disorders, or neuropsychiatric conditions, in a community integrated model of care. We primarily serve adults but may occasionally serve older adolescents or minors who are at least 16 years of age and who may not have access to a specialty pediatric rehabilitation program best suited to their specific service needs.

Individuals in community based residential settings reside in specialized, licensed group homes, or supported living apartments integrated within local communities. Residents are assisted to maintain health and safety, and to develop a productive routine of daily activities designed to improve or increase functional participation in community life. Therapeutic and habilitative activities are dynamic, vary in scope and focus, but may include educational, pre-vocational or vocational, cognitive remediation, recreational, and community living and other functional life skills, according to a daily community activity scheduled developed for and provided to each resident. Transportation and assistance in accessing a range of community activities are provided for all residents. Activities may include: working out at the local gym, grocery planning and shopping, work skills development through vocational placement or volunteering at various establishments, leisure and recreation development activities, academic involvement and adult learning opportunities, service or social group gatherings, eating meals at various locations within the community, group wellness classes, library access, attending concerts, going to movies, going to sporting events or directly engaging in sports activities, and similar activities. The program is designed to provide opportunities for residents to learn to effectively apply compensatory strategies and skills learned in therapy or in the home environment to daily community living. Medical Alternatives promotes and incorporates natural community supports within the service framework to meet the unique needs of the people we serve. Respite services are also available for survivors living at home who need supervision and care in the temporary absence of family members based on availability.

Spinal Cord Injury

In most instances etiology is related to impact trauma (i.e., MVA). Medical need impacts admission and level of care related to the level of a spinal cord injury. For example, individuals requiring a Tracheotomy or Mechanical Ventilation are outside of our scope of care. Care needs for Persons Served with spinal cord dysfunction is reviewed prior to admission to determine level of care and required resources to provide that care.

The purpose of the program is to be able to provide individuals who have sustained a traumatic brain injury the following:

Designed to foster independence, appropriate social skills, interact with peers, family members as well as others in the community, increase cognitive ability and quality of life, 24 hours of personal care and supervision to maximize safety in the home and community.

Services Offered

Specialized Residential Group Homes
Supported Community Program
In-Home Care
Transitional Services
Occupational Therapy
Physical Therapy
Home Based Therapeutic Exercise Programs
Medical and Therapy Services Coordination
Care Coordination
Nursing
Medication Management & Administration
Individualized fitness programs
Respite services
24-Hour On-Call Support
External Psychotherapy
Cognitive Behavioral Therapy
Family Education & Training
Individual and Group Social Activities
Community Based Recreational Activities
Art Activities and Groups
Social Group Involvement
Training in Community Living Skills, Domestic Skills, Life Skills, and Social Skills
Programmatic Transportation
Community Reintegration

Hours of Operation

In Home Care and Supported Community programs provide 1:1 staffing according to the individual service needs of the person, and physician prescription. When prescribed, 24-hour supervision and programming can be provided on an individual and short-term basis.

In Residential (Group Home) environments, 24-hour supervision is always available at a minimum daytime staff ratio of 1 staff to 2 participants. There is a minimum of 1 staff providing direct, active supervision in each residence on 3rd shift. Depending on the unique service needs of each group home population, 3rd shift staffing may increase to 2 staff.

Medical Alternatives maintains normal business hours, Monday – Friday from 8 am to 5 pm. Administrative and key clinical staff is available 24 hours per day for emergencies. During the times when an administrator is not within the environment of the program and an emergency arises, an on-call system is in place. Staff are trained on emergency protocol and procedures during new hire orientation and annually.

Admission Criteria and Guidelines

Adults who are aged 18 years or older with a diagnosis of an acquired brain injury, spinal cord injury or other severe orthopedic injury, neurological disorder, or neuropsychiatric condition.
Adolescents 16 yrs. or older, may be considered for admission with appropriate waiver from Michigan Adult Foster Care Licensing. Admission will only be considered if the candidate does not have access to a specialty pediatric rehabilitation program best suited to their specific service needs, or to preserve proximity to critical family and / or community support.
Need for up to 24 hr. supervision, support, and structure to maintain basic health and safety.
Potential to benefit from Medical Alternatives services and to meet the functional outcomes established.
Submission of pre-admission documentation or information to adequately conduct intake assessment and determine suitability for admission.
Completion of all admission documentation and licensing documents.
The individual’s goal is to increase or maintain independence in daily living, self-awareness, productive activity and to integrate into the community at the highest level possible; or, the individual’s level of disability causes him or her to be unable to acquire increased skills, and the person is in need of long-term care in a closely supervised, group home setting.
Behaviors that may be dangerous to self or others are able to be managed with behavior treatment, and do not represent a serious risk to health and safety of others living in the home.
The individual is not ventilator dependent.
Medical condition is stable and medical needs are able to be managed within a group home environment.
Documented evidence of funding.
Physician’s prescription specifying the need for placement in a group home setting requiring 24-hour supervision.
We cannot accept, retain, or care for a resident who requires continuous nursing care. This does not preclude accommodating a resident who becomes temporarily ill while living in the home.
We cannot accept or retain a person who requires isolation or restraint.
Admission is contingent on the resident’s prospective compatibility with other residents and members of the household.
At the time of admission and at least annually, a written assessment plan shall be completed with the resident or the resident’s representative. A copy will remain on file in the home when a sudden adverse change in the residents physical or mental condition occurs, needed medical care will be obtained and the resident representative notified.
If a resident is referred and accepted for emergency admission and the licensee agrees to accept the resident a written assessment plan will be completed within 15 calendar days after admission and will be done in accordance with the state licensing rule.
At the time of admission, a written resident care agreement will be reviewed and completed. This will be kept on file and reviewed annually or more often if necessary.
The resident care agreement is the document established between the resident, or the resident’s representative, or the resident’s responsible agency and the licensee which specifies the responsibility of each party. The following items can be found in the resident care agreement: Fee for service, description of additional costs, transportation fee and a description of transportation services.
House rules will be provided to the resident upon admission and reviewed annually or sooner if needed. A copy of the Person Served Handbook will also be provided. Supported Community admissions will receive a copy of the Person Served Handbook.
A written copy of the discharge policies and procedures along with a home refund policy will be provided.
Medical Alternatives does not handle funds for resident’s but will follow rules if such occasion does present itself with the Part II of the funds and valuable sheet.
A current health care appraisal will be obtained upon admission and annually. For emergency admission one must be obtained within 30 days for an emergency admission.
The residents and resident representative allow the program to contact physicians and to utilize all information to assist the residents.
A copy of Resident Rights and Responsibilities will be provided upon admission and reviewed annually.
The amount of personal care, supervision, and protection that is required by the resident is available in the home – 24-hour supervision and transportation.
The kinds of service, skills and physical accommodations that are required of the home to meet the resident’s needs are available in the home – barrier free.
Physician prescription specifying what services are needed.
While residing in the program the residents are protected by the following resident’s rights:
1. Shall not be discriminated against on the basis of race, religion, color, national origin, sex, age, handicap, marital status, or source of payment.
2. Shall not be denied or restricted in exercise of his or her constitutional rights, including the right to vote, the freedom to practice the religion of his or her choice, the right to freedom of movement and freedom of association.
3. A licensee shall not change the residency of a resident from one home to another without the written approval of the residents designated representative or responsible agency.
The program will maintain a current license and abide by all administrative rules.

Estimated Length of Stay/Admission:

Estimated length of stay/admission is determined by the treatment team evaluation of therapy process and goal outcomes. This is reviewed at least annually and documented by an updated prescription.

Transition Criteria

Person Served meets the outcome goals as specified in their rehabilitation plan and has improved skills to a degree sufficient to be able to be served in a supported independent living program without the need for 24 hr. care, or in a lesser restrictive environment. Typical outcome goals include sufficient improvements in self-care, managing a household, managing personal nutrition and food preparation, behavioral self-management, ability to maintain personal health and safety, managing one’s personal and business affairs, making effective use of strategies to compensate for cognitive and behavioral impairments, or becoming competitively employed or otherwise engaged in volunteer work, sheltered work, school, or other meaningful, productive day activity.
Behavioral sequelae are sufficiently self-managed to not present a danger to self or others.
Availability of a lesser restrictive placement setting to accomplish transfer.
Discharge/follow-up plan is in place prior to exit from the program.
Person Served is not capable of maintaining entry criteria. An alternative placement site/service provider will be identified prior to exit from the program.
Completion of all discharge planning and documentation.

Discharge Criteria and Guidelines

Medical Alternatives will maintain the resident in the home if the following criteria are met:
1. The amount of personal care, supervision and protection required by the resident is available in the home.
2. The kinds of services and skills required of the home to meet the resident’s needs are available in the home.
3. The resident’s needs are compatible with other residents and members of the household.
4. The program determines placement to be inappropriate.
A 30-day written notice will be given prior to discharge from the home. The notice shall state the reason for discharge. A copy of the written notice will be provided to the resident and the residents designated representative. Exceptions to the 30-day written notice are:
1. Substantial risk or an occurrence of self-destructive behavior.
2. Substantial risk or and occurrence of serious physical assault or destruction of property.

When such basis or a discharge exists, 24-hour prior verbal notice followed by a written notification will be given.
The reason for the proposed discharge, including the specific nature of the substantial risk.
The alternatives to discharge that have been attempted by the licensee.
The location to which the resident will be discharged, if known.
And a copy shall be provided to the licensing authorities.

The program will make an attempt to plan a discharge planning meeting and provide the necessary documentation to ensure for an appropriate transition. There may be a cost for making copies of records outside of the discharge planning process.
When there is a sudden adverse change in the residents physical or mental condition occurs, needed medical care will be obtained and residents representative will be notified.
The following resident rights are guaranteed by the licensing act and administrative rules:
1. Shall not be discriminated against based on race, religion, color, national origin, sex, age, handicap, marital status or source of payment.
2. Shall not be denied or restricted in exercise of his or her constitutional rights, including the right to vote, the right to practice the religion of his or her choice, the right to freedom of movement ad freedom of association.

Staffing

Clinical staff are licensed and certified to provide services in each specialty service area. Direct Support Staff provide supervision, assist with daily activities and functional skill development, and also provide specialized treatment, habilitation, and rehabilitation services according to individualized programs.

Direct Support Staff must have a high school diploma, and successfully complete established Medical Alternatives training. Direct Support Staff also complete training related to the individual participant’s service needs. Qualified and certified professionals in TBI, supervise and train the direct care staff.

Medical Alternatives is an equal employment opportunity employer.

Employment decisions are based on merit, qualifications, abilities and business needs, and not on race, color, citizenship status, national origin, ancestry, gender, sexual orientation, age, religion, creed, physical or mental disability, marital status, veteran status, political affiliation, or any other factor protected by law. Medical Alternatives complies with the law regarding reasonable accommodation for employees with disabilities.

Administrative and program management personnel ensure consistency and quality of services and efficiency of support operations. All staff must pass criminal background checks prior to employment. Direct Support Staff additionally undergo driving record checks that are updated annually. Job Descriptions, including performance, experience, and training requirements, are available for all positions within Medical Alternatives and provided to staff at time of application.

Staff Titles

Executive Director
Case Coordinator
House Manager
Assistant House Manager
Logistics Manager
Direct Support Staff
Physical Therapist
Occupational Therapist
Recreational Therapist
Vocational Program Manager
Vocational Job Coach
Certified Nurse Assistant
Administrative Assistant
Office Manager
Human Resource Generalist
Quality Improvement Manager

Training

Medical Alternatives elicit feedback from all stakeholders (program individuals, families, and agencies, employees) to refine ongoing staff education and training priorities and to improve training regimens. Additional training needs often emerge during clinical team meetings, continuous quality improvement or other administrative meetings.

All staff expected to complete new hire orientation by utilizing the Training Toolbox along with additional trainings provided via the New Hire Orientation binder.

Clinical and professional and staff, or staff with special certifications or licenses, are required to maintain on-going continuing education credit requirements.

All staff receives a minimum of 40 hours employee orientation that includes a mentoring process and formal training in:

Medical Alternatives Fundamentals Training including individual rights, and person-centered treatment planning
Abuse and Neglect Training
OSHA training including Infection Control/Universal Precautions/Blood Borne Pathogens
Safety and Hazard Communication
Emergency Procedures (fire, disaster, etc.)
CPI (Crisis Prevention Institute) or NAPPI (Non-Averse Physical and Psychological Intervention) which includes prevention of and management of disruptive behaviors
CPR & First Aid
Health and Medical Issues - including seizure disorder, skin integrity, swallowing disorders, diabetes overview, spinal cord dysfunction, oxygen use, etc.
Transfer/Body Mechanics Training
HIPPA/Confidentiality
Code of Conduct
Person Served Rights/Responsibilities
Injury Accident and Incident Reporting
Risk Management/Incident Reporting
Medication Administration Training – simulated med pass training
Workplace Violence Prevention Training
Employee Harassment Training
Suicide Prevention
Professional Boundaries
Basic Brain Injury 101
Cultural Diversity
Safe Handling Techniques
Safe Food Handling
Safe Drivers Training