Maine needs fund for brain injury

This week, the Legislature’s Joint Standing Committee on Health and Human Services will be considering the merits of LD 722, a bill that would create an acquired brain injury trust fund, modeled on similar trust funds in 19 other states. This is a long-overdue reform that will allow Maine to begin developing a more effective service system for people with brain injuries.

Brain injuries take many forms and vary in severity. Physical symptoms can include anything from seizures to paralysis, but often there are no visible signs of disability. In many cases, the most debilitating aspects of brain injury relate to thinking and emotion. Often people with brain injuries are unable to engage in cognitive tasks that most of us take for granted. Memory, judgment, concentration, and impulse control can be impaired.

Many Maine citizens have brain injuries, with sources ranging from car accidents to armed combat. Assuming that Maine follows national trends, roughly 26,000 Maine people currently have a long-term or lifelong need for help to perform activities of daily living, due to brain injury.

Despite the prevalence of brain injuries, however, people with brain injuries and their families cannot access the level of services available for other types of disability. For many, the lack of community integration and other services leads to placement in out-of-state facilities, at Maine’s expense, creating unnecessary hardship for those people and squandering an opportunity to invest state health care money in Maine businesses. Moreover, the lack of public and professional awareness of brain injury leads to an unnecessarily high rate of brain injuries each year, and a failure to diagnose those injuries early enough to treat them at a lower cost.

All of this adds up to a reduced quality of life for individuals with brain injuries and their families, and to unnecessary expenses for the state. Maine needs to catch up with the rest of the nation in creating a comprehensive, cost-effective brain injury services system. System development is all the more urgent, as many of our citizen soldiers are returning from Iraq and Afghanistan with severe brain injuries, and they cannot receive proper services in their communities if Maine does not develop more options for all people with brain injuries.

LD 722 takes a very modest step in that direction. It would appropriate $1.4 million per year to fund vocational supportive services, community integration services, supported living services, and information and referral services for people with brain injuries. Those funds would also address public health needs such as prevention efforts and public and professional education around brain injury. A portion of the funds could be used to leverage MaineCare dollars for certain brain injury services, and a small portion would pay expenses of a State Acquired Brain Injury Advisory Council, as well as administrative and personnel costs for managing the fund.

Though no funding source has been specified, most states with brain injury trust funds rely on vehicle registration fees or traffic fines for funding, because car accidents are a leading cause of severe brain injuries. A mere $1 surcharge on automobile license fees in Maine could fully fund the trust fund.

States have relied on trust funds for a number of reasons. First, it makes sense to tie funding for brain injury to activities that cause it. Second, brain injury tends to be a lifelong disability, with ongoing needs and costs. Wide variations in funding can have a serious impact on the effectiveness of services provided. Unfortunately, brain injury funding is a frequent target for budget cuts.

The services that the brain injury trust fund would provide actually save the state money in the long term. Obviously, prevention of brain injuries is one of the most effective ways to reduce the costs of brain injury. Public and professional education to ensure early diagnosis and proper treatment of brain injuries makes recovery more likely and reduces long-term service needs. Increasing public awareness of brain injury will make it easier for people with brain injuries to return to life and work in the community. Generally, providing services to promote community integration and return to work are much less expensive than placing people with brain injuries in nursing facilities and other restrictive settings.

Each of us is only one car accident away from a brain injury, and we should have a brain injury service system that reflects what we would all want for ourselves and our loved ones, if tragedy struck. All Mainers should be able to live with dignity in their communities, close to family, with sufficient services to maximize independence, good health and safety. I hope the Legislature will pass LD 722, and take an important step toward recognizing that right for people with brain injuries.

Clifford Ginn is a staff attorney for the Disability Rights Center, Maine’s protection and advocacy agency for people with disabilities.