A family-focused long-term care residence
Program limitations: Granite House is not a nursing facility and does not provide 24-hour Registered Nurse care. Granite House is also not a rehabilitation facility and does not employ professional on-site physical or occupational therapists to provide services to those who have progressed above the Minimally Conscious State.
BRAIN INJURY- SPECIFIC CARE
People with severe and permanent brain injuries have very different needs from other groups. This is why a traditional long-term care facility may be an inappropriate placement for people who are in a minimally conscious state. At Granite House, we understand that our residents need to be watched at all times when they are out of bed and in their wheelchairs. For this reason, they will not be left alone in their bedrooms once they have been transferred to their chair. They are not able to call for help or even push a call button, and cannot verbalize their discomfort. With a carefully written care plan, a resident will be satisfied when his or her schedule is followed.
We at Granite House will be following the coma stimulation program used by the major brain injury centers, employing distinct periods of alternating stimulation and rest time. The brain needs stimulation but it should be varied and monitored. While the residents are up, they will have appropriate stimulation and full supervision. This includes sunshine, fresh air, companionship, therapy, and noises common in a home. It will also include sensory stimulation to maintain the connections in the brain that detect smell, sound, touch, taste, and sight. Even just varying the sound is important, from playing jazz for 20 minutes, then classical, to singing, reading aloud, or quiet conversation.
Since the residents will all be incontinent and need to be changed every few hours, they will be transferred to and from the bed to chair often. A typical day would be three periods of 2 to 2 ½ hours up in the chair: mid morning, mid- afternoon, and early evening. When the residents are in bed, they will have safe, quiet time with lower stimulation, according to their care plan.
MODEL OF CARE
Granite House is not intended to be a medical facility, nor will it be a rehab facility. Our purpose is to offer a home-like setting for the long-term care of people who are not likely to emerge from a minimally conscious state, yet are otherwise stable and responsive to external stimulation. The dwelling and activities of daily living at Granite House are modeled on actual home settings, creating a safe, peaceful, accessible environment.
Services offered beyond the daily living cares will include music therapy, massage therapy, sensory stimulation, range of motion and weight-bearing therapies, and hydrotherapy. Features in the home include a large gathering space, gas fireplace, screened porch (Summer 2019), ceiling lifts for transfers, and quiet bedrooms for stimulation-free rest times. We will model our residents’ schedules after the “coma stim” program at Bethesda Rehabilitation Hospital, with periods of appropriate stimulation alternating with periods of rest.