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As ‘Managed Care’ Looms on Horizon, Hamaspik’s NHTD/TBI Programs Still Deliver Agency’s Niche Service Brings the Caring Literally Home across Brooklyn and Upstate

The Nursing Home Transition and Diversion (NHTD) Waiver Program is designed to help people in nursing homes come back home—or never move into a nursing home from home.


The Traumatic Brain Injury (TBI) program shares that mission.  It helps people who’ve suffered complex brain damage to leave nursing homes, or to live as typical a life as possible at home.


And in effectively delivering both, Hamaspik’s teams of trained professionals are right at home.


Transitioning to a better life

Under the leadership of NHTD/TBI Program Director Mrs. Tzivia Frommer, LMSW, fellow social workers Ms. Miriam Klaczkowski, Mrs. Aviva Salamon and Mrs. Pearl Spira better lives daily: advocating, supporting and otherwise championing each individual as the worthy cause that each is.


For people needing nursing-home levels of care, staying (or coming back) home can be involved. 


That’s why the NHTD program offers a wealth of targeted supports. And that’s why Director Frommer and team find themselves busy each day navigating and delivering those supports.


Among those supports is their very work itself—a service dubbed Service Coordination (SC).


But in serving as SCs, the Hamaspik professionals help their NHTD clients get in-home aides to actively assist and monitor them for up to 24 hours a day.


That provision is known as Home and Community Support Services (HCSS) and is by far the program’s most popular and in-demand service, Mrs. Frommer notes.


At Hamaspik of Rockland County, helping people on the NHTD program also looks like securing them Assistive Technology (AT)—and advocating tirelessly when initial requests for said items are occasionally turned down.


Assistive Technology refers to health-related home equipment whose costs are typically covered on a per-case basis—like the specialized, much-needed stationary bicycle that the Hamaspik team recently pushed for and secured for an older gentleman who has progressing Parkinson’s.


But the Hamaspik Rockland team not-infrequently draws upon other supports in NHTD’s stable of services.


Among these are Community Transitional Services (CTS), which covers the direct costs of home basics for people moving from nursing homes into unfurnished homes.


Another popular support is Environmental Modifications (E-mods)—a veritable staple in many of the active cases in Hamaspik’s files.


Said home renovations revolve around disability accessibility, and typically consist of walk-in (or roll-in) showers or bathtubs, non-slip floor surfaces, and the ubiquitous wheelchair ramps.  A fairly wide range of additional modifications may be made to the home of the individual in question—all depending on the person’s specific needs.


Helping heal invisible wounds

The other half of NHTD/TBI is, of course, the Traumatic Brain Injury Waiver program.


At Hamaspik of Kings County, seasoned staffer Mrs. Silberman has presided over a growing number of TBI clients in recent years—unfortunate but unavoidable growth resulting in the agency taking on new social workers to serve exclusively as SCs for the NHTD/TBI programs.


That growth has also resulted in the experienced SC’s promotion to NHTD/TBI Supervisor.


Under the knowing leadership of Mrs. Silberman, SCs Mrs. Surie Katz and Mrs. Sara Lowinger devote their daily time at Hamaspik wholly to the agency’s NHTD population, while SC Mrs. Chava Laufer works with NHTD and TBI clients as well.


Considering the involvement and nuance of traumatic brain injury, it’s understandable that Hamaspik would dedicate a single SC to working just with that population.


Besides being difficult to diagnose, traumatic brain injury is an involved condition for another tragic reason: the significant, long-term and too-often permanent negative changes in personality and temperament that such injuries cause in their victims.


That very fact is the reason New York State created its TBI program in the first place—to give suffering families much-needed long-term support as they weather the changes in their loved one and do their best to adjust to a trying new normal.


Traumatic brain injury is tragically known for making easygoing, loving and independent people irritable, fearful, unreasonable and otherwise incapable of self-care—putting agonizing strain on relationships between husbands and wives, or parents and children.

If there’s anywhere that help is needed, it’s here—which is where the social workers of Hamaspik come in.


Working directly with both the TBI patient and his or her family, Hamaspik’s TBI program specialists work towards the program’s mission of keeping the individual who needs a nursing-home level of care out of nursing homes.


And to accomplish that, Hamaspik’s TBI SCs deploy a program toolbox that can provide, among other things: housing, medical equipment and supplies, independent living skills training, and even transportation.


Unchanged present, changing future

The NHTD and TBI programs are delivered by qualified non-profits like Hamaspik under the auspices of the New York State Dept. of Health (DOH). 


Both are funded by Medicaid, the state/federal healthcare program for the poor. 


Both are also Waiver programs, so dubbed for their waiving of various standard Medicaid regulations.  What that means is to obtain either program, one first must secure membership in Medicaid.  Once that’s done, the individual need only meet either program’s requirements to begin obtaining services and supports.


Like several New York State Medicaid-funded programs, both are also slated for transition to managed care, a new payment model now being piloted by Medicaid in other programs.


As far as tangible benefits are concerned, it remains unclear what changes if any managed care will usher in.  Regardless, any changes will only be first kicking in on January 1, 2019—and in the meantime, provider advocates are working to ensure that both remain as intact as possible.


Another big change coming to NHTD/TBI is Conflict-Free Case Management (CFCM).  In plain English, that means that your SC can’t work for the same agency as your program provider. 


Like the transition to managed care, that change is also not exactly happening tomorrow.  What’s more, according to industry insiders, the exact nature of that change is also in constant change.


For now, and until at least January of 2019, both programs remain in full force exactly as is.


Tending to those affected by traumatic brain injury remains a front of vital importance to Hamaspik’s ongoing mission of providing community human services.


That community need for TBI services is underscored by a June 12 study in the American Journal of Preventive Medicine—a study that found that people with TBI are also at the highest risk of adverse outcomes. 


That fact, long known to New York health officials and policymakers, is one of the key reasons behind the state TBI Waiver program’s initial creation—and also one of the reasons that Hamaspik has long offered the effective program.


However, the TBI program at Hamaspik is essentially proactive in nature, not reactive, notes Mrs. Frommer.  Service Coordinators helps each TBI beneficiary focus on the positive, with the SCs “tapping into participants’ individual strengths and encouraging them to become more independent.”


But for now, regardless of what the future brings, Hamaspik’s NHTD/TBI teams are carrying on—bringing a full regimen of Hamaspik’s trademark caring home.