Residential rehab for the disabled young.

The Courage Residence in Golden Valley, Minnesota, is a residential rehabilitation program for severely physically and cognitively disabled young adults with an average age of 24. More than 1,500 of them have lived in the residence since it opened in 1976, with an average stay of about 10 months. At Courage Residence, up to 64 residents at a time are provided with a comprehensive program of rehabilitation, mental health services, vocational services, daily living training and other services that help them to make a transition to self-reliant living, a unique concept when the residence was founded.

Courage Residence offers three specialized programs focusing on the specific needs of those with brain injuries, spinal cord injuries or congenital disabilities. Staff and residents operate within a results-oriented program based on the residents' individual goals and skill levels. Residents spend seven days a week in rehab - but rehab involving a cornucopia of services and activities: physical and occupational therapy, psychological services, therapeutic recreation, medical services, music and art therapy, vocational services, community living planning, attendant care management training, driver assessment and training, money management, life enrichment classes, and recreational and social activities.

Residents also have access to a full continuum of services, such as swimming, camping, sports, job placement and much more through the Courage Center, which operates the Courage Residence as one of its 70 programs and serves more than 20,000 people with disabilities. Former residents also have access to a variety of services, including psychology services and independent living skills training.

Courage Residence was originally meant to serve as a permanent home for its residents, but it was found that most clients were able to live independently or semi-independently. Of those who have stayed at the residence, most of whom were admitted from institutions, 84% are now living independently.

The residence can also boast of successful outcomes by other measures. By the end of 1996, for instance, it was found that 83% of all former residents report an increased ability to perform daily living activities and that 83% are working, going to school or otherwise participating in the community. One brain-injured woman has been able to move to an assisted living facility and return to her old job on a volunteer basis.

For the past several years, Courage Residence has received perfect or near perfect marks on state inspections across the board: the Minnesota Department of Health state licensing and federal certification surveys, the Minnesota Department of Human Services Quality Assurance and Review Survey, and the Minnesota Department of Human Services Rule 80 Survey.

Research has shown that the services provided by Courage Residence led to a dramatic reduction in private and public financial support over the life span of disabled persons served there. Client service, for the most part, amounts to less than a quarter of the cost of an acute rehabilitation facility - important in this day of managing healthcare dollars effectively. This is particularly important in that the need for such services is growing as techniques in trauma, neonatal and coma care continue to advance and save lives, thereby increasing the number of people with severe disabilities.

Because of this, skilled nursing facilities are acting increasingly as providers of rehabilitation and subacute care for people of all ages. They have the core resources needed for such activity, e.g., unfilled beds, nursing staff, food service and rehabilitation services. With training in meeting the special needs of young adults with disabilities, along with providing services such as vocational training, driver training and other daily living activities, the Courage Residence model might be replicable for managing specific groups of disabled young people. A number of factors that differentiate the care they require from what is usually provided in skilled nursing facilities shouldn't be overlooked, however.

For example, Courage Residence's mission focuses on transition. Residents are expected to drive the process, leading the planning of their own rehabilitation from day one, always with an eye to the future and guided by four transition specialists. Obviously, the need for such specialists demonstrates that staffing needs differ from those of the average skilled nursing facility.

Also, the emphasis on psychological development calls for a staff of seven psychologists at Courage Residence, and tutors are needed to give scholastic aid. CNAs take an activist role here, learning to work with residents rather than do things for them and helping them learn to deal with personal care assistants in future life. Moreover, the Courage Residence's philosophy of holistic care means that its ties to the community go far beyond the usual to encompass a heavy emphasis on vocational training and driving, in line with residents' need to direct their own futures. These are all factors nursing homes must take into account when considering adding services for the disabled young.

Kathy Bakkenist is director of residential services at Courage Residence, Golden Valley, MN. For further information, call [phone].