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About Our Program
1. What does "transitional" mean?
Transitional means that the client has been assessed by various members of the treatment team and based upon
all available information including previous medical history is most likely to benefit from therapy and/or
psychosocial services and eventually be reintegrated to home and community
2. What does "Long term care" mean?
Long Term Care or supported living indicates that the individual has most likely reached a relatively stable functional
level with limited progress expected. Usually, complex physical and/or behavioral issues preclude this person
from living independently.
3. Do clients ever stay for life?
We have clients who have been with the program since its inception and, based on those same complex physical
and/or behavioral issues previously mentioned, it is anticipated that they may never be able to reintegrate
back into the community and/or with their families. Our clients' needs are assessed periodically to ensure
that TOL remains the most appropriate placement for them.
4. What does "supervised living" mean?
"Supervised" living simply means that a client has progressed to a level which would allow them to live in a
Tree of Life apartment with trained staff available to supervise the client to the extent required. This
could mean 24 hour per day availability on the part of the staff or perhaps "graduation" to just a few
hours of supervision per day depending on each client's individual needs.
5. What kind of doctors do you have at Tree of Life?
Dr. Nathan Zasler, whose specialty is Physical Medicine and Rehabilitation, is our Medical Director, and
oversees the coordination of care for all of our clients. Additionally, we have two neuropsychologists, Michael
F. Martelli, Ph.D. and Mark C. Bender, Ph.D., as well as a team of specialists including Occupational Therapy,
Physical Therapy, Recreational Therapy and Speech Language Pathology.
6. Are doctors and nurses located on the premises?
Our medical director is on call 24 hours per day, 7 days per week unless out of town. Our program nurse
monitors patients on a weekly basis and the Clinical Program Director is an RN who is also on call for
consultation and emergencies.
7. Do you have 24 hour staffing?
Yes. Our facilities are staffed 24 hour per day by Life Skills Therapists (LSTs). Most of our LSTs are
also trained to assist with the administration of medications, as well as having Cardiopulmonary Resuscitation
(CPR) and First Aid and crisis intervention training
8. Is there a minimum length of stay in the transitional rehabilitation program?
Length of stay is dependent upon each client's goals and progress toward those goals. We feel that, in most cases,
it takes at least three to six months for our clients to successfully mainstream back into the community. However, some
clients may require a longer length of stay.
9. What is the average length of stay for the transitional rehabilitation program?
It is difficult to provide an "average" length of stay since each client is different simply by virtue of
diagnosis and deficits. Typically, however, our clients stay at least six to nine months.
10. Can family and friends visit at any time?
Families and friends are always welcome as part of the team and as an essential link to our clients' lives.
We do ask that the visits are planned in advance so they do not interfere with scheduled activities and therapies.
11. Is your facility like a hospital?
Not at all. Our clients have moved past the need for a hospital setting. Tree of Life provides a home-like "real life"
community environment to foster more independent living skills.
12. How many clients share a room?
Currently all of our rooms are private rooms.
13. Do clients get home visits?
Home visits are encouraged, when appropriate, in an attempt to maintain good quality family relationships and to
assess behaviors in the home setting assuming that this is the likely discharge disposition. This can give the team
direction for goals and interventions when the client returns to the program. A process of "weaning" back to the
home gradually can often be the most effective way to achieve a successful reintegration.
14. Can the clients go shopping, out to eat, to movies and concerts?
They do all of these activities, and more, either as scheduled recreational events or sometimes as part of a
"reward" system for specific behavioral plans.
15. Do clients fix their own meals or does someone else prepare them?
Life Skills Therapists (LSTs) are always available to prepare meals from a posted menu. LSTs also do most of the
grocery shopping. However, clients are scheduled to participate in as much of the shopping and/or meal prep
as they are capable of doing. This could be anything from simply preparing one part of the meal, to completion of a full meal.
Admission Criteria
1. Do you accept teens and adolescents?
Based on our current licensing through The Virginia Department of Social Services our clients have to be 18 years of age.
2. Do you accept dementia/Alzheimer patients who do not have acquired brain injuries?
We do not accept individuals with this diagnosis.
3. Do you accept patients who use wheelchairs or other mobility devices?
Yes.
4. Do you accept patients who are incontinent?
We have clients who are incontinent and may be working on a bowel and bladder program with the goal of improving
incontinence. We also accommodate individuals who, based on their neurologic disorders, will remain incontinent of bowel and bladder.
Treatment
1. Do you have a program for patients with behavioral and anger management problems?
We have two neuropsychologists whose expertise is in the development of neurobehavioral programs to mediate
the behavioral concerns most often seen after a brain injury. Both are available in our clinic as well as on-site
to educate and train staff regarding behavioral issues. We screen potential clients to determine if they pose a significant safety
risk to themselves and/or to others. If their level of aggressive behaviors or their risk for elopement is excessive, we may not
consider Tree of Life to be the most appropriate setting.
2. Does your program deal with chronic pain issues in persons with TBI?
Yes. Our treatment team has extensive experience with the treatment of chronic pain. Additionally, both Dr. Zasler and Dr.
Martelli are diplomats of the American Academy of Pain Management.
3. What type of therapies do you provide? Is it provided on the premises?
We provide physical, occupational and speech language therapies, neuropsychology and therapeutic recreation both in the
client's setting and at the therapy area within the Tree of Life house. On an as-needed basis,
we also utilize specialty therapists/services from the community. Pet therapy, massage therapy, music therapy, vocational
and pre-vocational services at Mill House, volunteer placements and nutritional consultations
are some of the additional services we coordinate as part of the client's program.
4. How often do patients see the doctors?
Tree of Life facilitates visits with primary care physicians, Dentists, Podiatrists, and Gynecologists on a routine
basis and specialists such as Urologists, Dermatologists, Surgeons, Orthopedic doctors or any other specialty on an as-needed
basis. We ensure that all existing medical problems are evaluated on a regular basis to maintain general good health.
5. Can family members talk with the doctors or the therapists? How often?
We always encourage our families to play an active role and encourage them to participate in our team meetings, either in
person or by phone. All team members make themselves available, as possible, with the understanding that we honor our daily
scheduled time with our clients.
Cost and Funding
1. What is the cost for residential and transitional services?
We accept insurance that provides for the services that we offer, workers compensation or private pay.
2. Do you accept Medicare?
Unfortunately, Medicare does not pay for this type of post-acute residential service.
3. Do you accept Medicaid?
Unfortunately, Virginia Medicaid does not yet pay for residential services, not even through the DD waiver. However,
Tree of Life is represented on a Medicaid panel that is looking at extending the waiver to include residential services
for individuals with traumatic brain injuries. Other states, however, may provide for residential coverage for this type of injury.
4. Do you have grants available?
At this time we do not offer grants.