Discussion of a rehabilitation program may be initiated by your physician, nurse, or managed care provider. A written referral from a physician is necessary for most insurance carriers and may be required by the rehabilitation facility. It is also important to contact your health insurance provider to fully understand your benefits. Inquire about included services, exclusions, and any limitations. Some policies limit the number of sessions or exclude certain services or facilities.

If you are not sure where to go, request a listing of facilities covered in your health plan. Be aware that some services are offered on an in-patient basis others on an out-patient basis. There are benefits and limitations with each. Discuss your options with your physician and insurance provider to determine which would best achieve your rehabilitation goals.

If your physician does not suggest a specific rehabilitation facility for you, call the Admission Office at facilities within your insurance plan or provider network. Prepare a written list of questions to ask and have a notebook handy to keep all this information in one place.

Here are some key questions:

• Do you treat brain tumor patients?

• Do you have an existing brain tumor or brain injury program in place?

• Ask them to mail information to you about their facility and their programs.

• Ask to speak with patients who have been through their programs to hear their opinions.

The types of services available varies at each facility. Look for one with services that would best suit your situation. All programs should include a medical component, overseen by a physician and assisted by a nurse and therapists. These may include physical, occupational, speech, recreational and/or psychological therapists. "Re-entry" programs cover returning to home, work, or school. Their goal is to reintegrate the patient into their home and community using a team-approach therapy that mimics the patient's real life situations and demands.

Once you choose a program and your insurance approves (if required), schedule an evaluation session. During that session a "baseline" assessment will be made by each specialist. Current abilities are measured objectively, then goals are written. This written evaluation, called an Individualized Written Rehabilitation Plan (IWRP), is an outline of personalized care. This Plan may include, but is not limited to: physical therapy, occupational therapy, recreational therapy, speech therapy, and psychological counseling. It is important to have the patient and/or a family member involved in the development of this plan to be sure the patient's needs will be met.

Once the program begins, progress will be monitored. This may be done by a therapist, case manager, or care coordinator. This individual coordinates all the therapies by regular monitoring. If the plan needs revision, a team meeting or goal conference may be arranged by this coordinator. This allows each specialist and the patient a chance to discuss the progress being made.

As the program progresses, remember it is never too early to begin thinking about discharge planning. Planning for future needs will help minimize last minute surprises. Will approval be needed from the insurer for adaptive devices or equipment? Plan enough time for that approval process. Will your home need to be adapted in any way? Allow time to plan the changes and locate appropriate resources. Will there be any special need accommodations at your work place or school? Allow reasonable time to get everything in order.

The choice of a rehabilitation program is an important decision in the recovery process. Working together with your physician, the accreditation commissions, and other referral agencies you will be able to locate a rehabilitation facility that will offer the best possible chance to enhance your skills.

RESOURCES

The Brain Injury Association, 800-444-6443, publishes a listing of rehabilitation facilities, a listing of state associations with 800 helplines, and offers limited financial assistance.

The National Rehabilitation Information Center, 800-346-2742, performs literature searches for patients looking for specific rehabilitation information, products or treatments. They also offer a listing of rehabilitation facilities.