The Help to Recovery Adult Day Healthcare Program (HTR) is a full-time rehabilitation program for adults who have sustained either an acquired or traumatic brain injury. Our program is licensed by the California Department of Aging. The overall goal of the program is to increase the participant's current level of function and improve his/her level of independence. Services are offered through a multidisciplinary approach and include Nursing, Medical Social Work, Activities, Physical Therapy, Occupational Therapy, Speech Therapy, and Nutrition. Participants are assessed at the time of admission and individualized treatment plans are developed for each discipline. These treatment plans are consistently evaluated and updated on a quarterly basis. Participants remain in the HTR Program for as long as there is medical necessity and he/she is within compliance with the program's participation policy.

HTR is open Monday through Friday, 9am-3pm, and is structured to offer a consistent, stable environment that treats the entire person. Families and/or caregivers are provided the necessary information and resources in order to use the skills learned and practiced in HTR at home. A dietician approved lunch is provided daily. Transportation is primarily provided by Paratransit.

The specialized rehabilitation services offered through the HTR program address each of the following challenges a survivor of brain injury may face:

Cognitive deficits include coma, confusion, shortened attention span, memory deficits, problem solving deficits, impairments in judgment, loss of time management skills, decreased awareness of self and others, and inability to accept multiple step commands. Survivors of brain injury have difficulty with abstract thoughts.

Motor deficits include poor balance and coordination, decreased endurance, poor initiation, spasticity (tightening and shortening of the muscles), tremors, swallowing difficulties, and paralysis or weakness.

Sensory deficits will include changes in hearing, vision, taste, smell, and touch, left- or right-sided neglect , vision deficits, and change of sensation of body parts.
Communication deficits include aphasia (difficulty speaking and understanding speech), apraxia (difficulty choosing the right words to say), decreased vocabulary, difficulties reading, writing, and working with numbers.

Functional deficits include difficulty with activities of daily living (ADLs – dressing, bathing, eating), organization, shopping, paying bills, vocational skills, and inability to drive a car.

Social deficits include social impairments, self-centered behaviors, and difficulties in making and/or keeping friends.

Personality changes may include decreased motivation, emotional lability, irritability, anxiety, depression, lower frustration tolerance, and inappropriate sexual behaviors.

Other disturbances may include fatigue, changes in sleeping and eating habits, headaches, loss of bowel and bladder control, and dizziness.

Participants work to meet their goals in a variety of large and small group activities, as well as group and individual therapy sessions. Components of the HTR program include, but are not limited to, the following groups:

Daily Schedule: Participants learn to schedule daily activities to increase memory and learn skills necessary for community success.

Be Here Now: Daily orientation and review of journal use and information previously stored. Review of calendar and current events. Focus on memory and attention. Provides leadership opportunities for participants as they are offered the opportunity to facilitate this group session.

Health Education: Instruction in nutrition, hygiene, medication administration, disease control and other important issues, lead by the Registered Nurses. Memory techniques are used to record, store and retrieve information.

Small Group Activities: Participants work in small groups on projects specific to their treatment plans and goals.

Structured Recreation: This is a daily activity that encourages appropriate social interaction and provides an opportunity to have fun in a structured environment.

Skills Session: Participants work on new learning in the areas of money management, telephone use, mobility training and other useful skills. Planning is a major focus of this session.

Awareness Group: This group is lead by the Social Worker and employs peer and group counseling. Discussion topics include goal setting, behavioral issues, family stress, and planning for increased independent living. Problem solving techniques are taught and used by the group.

Vocational Group: This group is lead by the Activities Coordinator and develops individual and team strategies for increased independent living. Vocational skills are advanced through experiential learning opportunities. Discussion topics include communication, time management, motivation, and goal setting.

Community Outings: Individuals and small groups practice skills learned in the program while out in the community. Participants are involved in the planning and evaluation of the outing. Great effort is made to incorporate activities that the participant might be able to duplicate independently or with family and friends.

Journals: Participants record factual information about their day during this session. It gives them a "memory" record. Using their journal techniques consistently enables them to overcome some of the problems associated with their memory deficit.

Relaxation: Training of alternative coping skills in dealing with the stress, anxiety, and frustrations of having a brain injury.

Potential participants are assessed by our Medical Social Worker. Admission criteria include:

Age: Participants must be age eighteen (18) or older.

Medical Stability: Participants must be medically stable and have proof of a negative TB test.

Medical Acuity: Participants may be moderately to severely cognitively impaired. Physical impairments must be able to be accommodated by current staffing. The HTR ADHC program is unable to accommodate potential participants that require 1:1 staffing.

Behavioral Issues: The HTR ADHC program is not able to consider potential participants who are physically aggressive. Potential participants may have had a history of physical aggression, but must have proof of stability at time of enrollment. Potential participants who have a history of verbal agitation will be assessed on a case-by-case basis. Any participant who makes physical contact with staff during their enrollment will be discharged.

Mental Health: Participants may have a dual diagnosis as long as the treatment team is in agreement that the mental health issues do not impede the rehabilitation potential of a participant. Potential participants with a dual diagnosis are assessed, if necessary, for compliance with medication and that the mental health issue is being addressed by either the primary care physician and/or a mental health specialist.

Family/Caregiver Participation: Family members and/or care providers must be willing to encourage and assist participants in the carry over of therapeutic strategies and techniques into the home and community.

Cultural/Spiritual Issues: The HTR ADHC program does not discriminate on the basis of ethnicity, religious preference, or gender. Non-English speaking participants would require a translator. The HTR ADHC staff reserves the right to determine if the program is appropriate for a non-English speaking potential participant if a reliable and consistent translator is unavailable. In such instances, the HTR ADHC program will attempt to provide a more appropriate referral.

Participants funded through Medi-Cal: Participants funded through Medi-Cal must meet the following in addition to the above criteria:

• Have a medical condition that requires treatment or rehabilitative services prescribed by a physician.
• Have mental or physical impairments that hamper daily living activities but are not of such a serious nature as to require 24-hour institutional care.
• Reasonable expectation that preventative service will maintain or improve the present level of function.
• High potential for further deterioration and probable institutionalization if Adult Day Health Care were not available.

Discharge planning begins during intake and successful discharge to a less restrictive environment is the program goal. Discharge will occur when:

Treatment goals have been met and maximum benefit of program is reached.

The participant is unable/unwilling to benefit from program services and every effort has been made to remove possible obstacles.

The medical or behavioral management needs of a participant can no longer be safely met by the program staff.

Participant becomes a danger to self or others.

We encourage you to contact our staff with questions, resources, or for additional information regarding our program or brain injury. We can be reached at 916-679-3120.