Newsletter & Blog

After a traumatic brain injury, many people can live at home and stay connected to their community, but they often need the right supports to make that possible. Families may also find themselves managing a long list of moving pieces, from daily routines to transportation to emotional changes that come with recovery.

That is where the TBI Waiver can come in.

This guide explains the TBI Waiver in plain English, the types of supports it may include, and how services like coordination, skills training, and structured programming can help a person build a stable routine at home. If you are exploring waiver-related support, RES outlines its approach on the Aging at Home and waiver programs page.

What Is the TBI Waiver?

The TBI Waiver is a Medicaid home and community-based program in New York designed to support people living with the effects of a traumatic brain injury.

The goal is to help eligible individuals remain in their homes and communities by coordinating services that support safety, independence, and quality of life.

Who the TBI Waiver Can Help

Eligibility details depend on program rules and personal circumstances, but families often start looking into TBI waiver support when they notice challenges like:

• Difficulty managing daily routines consistently
• Memory, attention, or organization issues that affect safety
• Emotional regulation challenges, such as irritability or mood changes
• Reduced motivation or difficulty initiating tasks
• Trouble leaving the home due to transportation or confidence barriers
• A growing gap between what a person wants to do and what they can do independently

What the TBI Waiver Can Include

A strong waiver plan is rarely just one service. It is usually a combination of supports that work together to make day-to-day life more stable.

RES describes several key service types commonly tied to waiver pathways, including:

Service Coordination

Service coordination is the “glue” that holds the plan together. A Service Coordinator helps guide services, keep progress moving, and reduce the chance of missed steps.

This is especially helpful when families feel like they are juggling paperwork, timelines, and multiple providers at once.

ILST: Independent Living Skills Training

ILST focuses on rebuilding day-to-day skills and routines that support independence. Depending on the individual, that can include areas like:

• Planning and organization
• Budgeting and money management
• Cooking and meal routines
• Self-care habits and daily structure
• Transportation planning and community navigation

ILST is often valuable because it is practical. It targets real-life obstacles that cause stress at home.

PBIS: Positive Behavioral Interventions and Supports

After a brain injury, behavior and emotional responses can change. PBIS focuses on reducing challenging behaviors and improving coping strategies, with support that is structured and consistent.

PBIS can be especially useful when challenges show up as:

• Mood swings or irritability
• Impulsivity
• Social withdrawal
• Difficulty focusing or completing tasks
• Adjustment challenges as roles and abilities change

Home and Community Support Services

This category focuses on health and safety support at home and in the community. It can include assistance with daily living tasks and routines that keep the person stable and safe.

Structured Day Program

A structured day program can support skill-building, routine, social connection, and confidence. It can also reduce isolation, which is a common challenge after TBI.

Transportation

Transportation support can be a make-or-break factor. Even the best plan fails if a person cannot reliably get to services, activities, or appointments.

How Service Coordination Makes Everything Work Better

Most families do not struggle because they do not care. They struggle because the plan is complex.

A Service Coordinator can help by:

• Keeping services aligned with the care plan
• Helping maintain eligibility and continuity of services
• Coordinating practical needs like transportation and schedules
• Linking a person to additional community supports when needs change

RES’s community services page explains how service coordination and related supports help people stay supported in the community, especially when multiple needs overlap.

A Simple Way to Think About Building a Strong Plan

If you are not sure where to start, this framework is helpful before you dive into the details.

Step 1: Identify the biggest daily-life friction points

Look for the moments where things break down, such as:

• Morning routine
• Medication reminders and follow-through
• Meal planning and hydration
• Getting out the door for appointments
• Overstimulation or end-of-day frustration
• Forgetting steps and losing track of tasks

Step 2: Match supports to the friction points

Examples:

• If the issue is follow-through, ILST can help build routine and structure
• If the issue is emotional or behavioral challenges, PBIS can help
• If the issue is complexity and confusion, service coordination can reduce it

Step 3: Build a plan that can evolve

Recovery and long-term needs can change. A plan that adjusts over time is often more successful than a rigid setup.

Common Misunderstandings About the TBI Waiver

“It is only for people who need intensive medical care.”

Many people living with TBI-related challenges do not need constant medical care, but they do need supports that help them function consistently, safely, and confidently.

“We should wait until things get worse.”

Waiting often creates crisis-driven decisions. Earlier planning can reduce stress, prevent safety risks, and keep options open.

“One service should solve everything.”

It usually takes a combination, such as coordination, skills training, plus structured routine support. The right mix depends on the person’s daily reality.

Practical Questions to Ask Before You Commit to Any Plan

These questions keep the conversation grounded in real life:

• What does a good day look like for the person we are supporting?
• What times of day are most risky or most stressful?
• What is the biggest barrier to independence right now?
• What support would reduce caregiver strain immediately?
• How will we track progress and adjust when a change is needed?

Answers Families Often Need

Does the TBI Waiver cover the same services for everyone?

No. Plans are individualized based on needs and program guidelines, and services are typically combined to fit the person’s goals and safety needs.

What if we are not sure which services fit our situation?

That is common. Many families start with a conversation focused on daily routine, safety risks, and goals, then build the plan from there.

Can these supports work alongside other care?

Often, yes. Some people need a mix of supports, such as skills training, coordination, structured programming, and in-home help, depending on their needs.

Do we need to understand every program detail before reaching out?

No. The most important first step is clarity on needs and goals. The rest can be guided with professional support.

The Next Step: Build a Plan That Feels Realistic

The best waiver plan is not the one with the most services. It is the one that actually fits day-to-day life and reduces risk.

If you are in Nassau or Suffolk County and want help understanding what services could support your situation, start with the Aging at Home and waiver programs page, then reach out to RES Home Care to talk through next steps.

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