Brain injury assistance needs more awareness, funding

(The Center Square) – Treating traumatic brain injury, or TBI, can be a long and costly road. Experts in the field say that leaving these injuries untreated or under-treated can be even costlier.

Members of the House Human Services Committee met providers and advocates to hear how the state is offering treatment and support for those with the condition and what more can be done to help.

Tara Trego, director of the Bureau of Family Health, told the committee that 86,000 Pennsylvanians suffer from brain injuries every year, with over 2,000 dying as a result of those injuries.

“While I knew that I was concussed, I had no clue that on a dime, the life I knew was gone and that I had lost my brain, the very thing that made me tick,” recounted Elayne Masters, a TBI patient and advocate.

Once someone has experienced a TBI, the course of their care is largely dependent on the doctors they first encounter. Often referred back to their primary care physicians, patients who are often experiencing cognitive dysfunction must navigate their way through a system of care including providers, insurance companies, and government-run programs. Any delays in this care can lead to significant setbacks in recovery.

Initiatives like the NeuroResource Facilitation Program, or NFRP, and the Pennsylvania Head Injury Program utilize a variety of state and federal grants to meet the complex needs of TBI patients and, ideally, help them get back to their work, school, and their communities.

NFRP connects patients to facilitators who help them figure out what they need and where to get it. HIP covers short-term rehabilitation services to return patients to independent living.

The injuries can happen to anyone in any state of health or phase of life. Certain groups who are more vulnerable to falls make up a large proportion of the injuries, including the elderly and those struggling with substance use disorder. Sports and combat are other common sources of injury, leaving high numbers of athletes and veterans affected by TBI.

Dr. Lori Grafton, co-director of Penn State Health’s Brain Injury Medicine Fellowship Program, says that psychologists need special training to understand the unique needs of brain injury patients. Traditional therapies that rely on memory and other cognitive and behavioral skills may be less effective for someone with a TBI. Meanwhile, medications for pain and neurostimulants can pose a threat to patients with substance use disorder.

“They really need psychologists and counselors that understand how these patients’ brains work and what might need to be adapted to make them successful,” said Grafton.

She also noted that the funding through programs like HIP is specific to cases where someone has suffered head trauma and would like to see coverage expanded to acquired brain injuries. These can come from illness or from prolonged oxygen deprivation to the brain, a common occurrence during drug overdose.

Last month, the committee joined the House Insurance Committee to hear about coverage options for TBI. Many TBI patient needs are covered through Medicare, Medicaid, and third party. For co-occurring issues – like behavioral, mental health, and substance abuse – some patients may be left on their own to manage the cost.

The neuro field is suffering from the same staffing and funding stressors as medical care across the state. Kristen Farry, executive vice president of policy and strategy at the Woods System of Care, said that the number of providers has shrunk from 18 to 14 in the past ten years where they have not seen an increase in Community Health Choices funding, which assists with long-term care, in the same length of time.

Her facilities, which accept Medicare, lose an average of $150 per day per client by providing necessary care that isn’t covered.

Dr. Victoria Harding of NeuroRestorative, a rehabilitation provider, spoke about the stresses.

“I just want to underscore that the lack of funding is really chiseling away at our ability to maintain a skilled workforce and is eroding access to specialized services that are provided to people in the commonwealth under the CHC reimbursement.”