Spinal Cord Injury and Disorders

To be eligible for SCI/D services, a Veteran must be enrolled in the VA system of care.
There are multiple options to enroll:

Apply Online:             
You can apply online: Apply for health care benefits

Apply by phone:

You can apply for enrollment of your benefits or update your information by phone by calling 1-877-222-VETS (8387), Monday through Friday, between the hours of 8 a.m. and 8 p.m. (Eastern Time).

Apply by mail:

You can apply by mail by printing the 10-10EZ form or call 1-877-222-VETS (8387) to have the form mailed to you.

Send your completed application to:

Health Eligibility Center
2957 Clairmont Rd., Suite 200
Atlanta, GA 30329

Apply in person:

You can apply in person by visiting a VA Medical Center or clinic nearest you to apply for enrollment or if you are already enrolled, to update your information.

Please visit the VA enrollment site for more detailed information.

If you are a Veteran that is already enrolled in the VA system of care and believe that you have a qualifying diagnosis, speak to your provider about a referral to our program. Individuals at an outside facility looking to transfer their care to the Hines SCI/D service can contact the Hines transfer coordinator at Ph#: ext. 22404.

The SCI/D Center has two 30-bed acute care inpatient units, fully staffed by a dedicated multidisciplinary treatment team including SCI/D Physicians, nursing, nutrition, social work, physical and occupational therapy, psychology, spiritual support, educational therapy, recreational therapy. Other services important to a person with a spinal cord injury, such as speech and swallow dysfunction, psychiatry, urology, neurology, neurosurgery, infection control, plastics, surgery, and vocational rehabilitation are available through in-house consultants.

Our Vision

That by providing necessary support and understanding, all injured Veterans will fully achieve their cognitive, emotional, and functional potential.

The Hines SCI/D Acute Rehabilitation Program has been CARF accredited since 2002. From 2009 through 2022 about 263 injured Veterans have completed the acute rehabilitation program. Approximately 41% of our rehabilitation patients have suffered a traumatic injury resulting in paralysis. Fifty-nine percent of our rehabilitation patients are admitted because of a spinal cord dysfunction resulting from non-traumatic diseases or disorders.

Our SCI/D Acute Rehabilitation Unit is fully staffed by a dedicated interdisciplinary treatment team. The Hines SCI/D Rehabilitation Program fosters and maintains patients’ overall health by providing medical, physical, psychological, vocational, recreational education and therapy as well as spiritual support for attaining the highest level of independence and quality-of-life.  

Other services important to persons with a spinal cord injury, such as speech and swallow dysfunction, psychiatry, urology, neurology, neurosurgery, infection control, plastics, general surgery, and vocational rehabilitation are available through in-house consultants.

We continue to follow Veterans after discharge including a 90-day follow up which is completed through an inpatient stay. The Veteran will meet with each service to review current status, progress and have the ability to voice any concerns after transitioning into the community.

Our Programs 

Hines SCI/D Center offers rehabilitation to Veterans with documented diagnosis of spinal cord injury/disorders who are experiencing a reduced level of function. The patient must have the cognitive capability and motivation to be able to participate in and benefit from rehabilitation.

Hines SCI/D Center has two rehabilitation programs.

CARF Intensive Acute Rehabilitation I   

Acute Rehabilitation I program provides services for those medically stable patients able to participate.
Therapy will provide six days a week for up to three hours a day to attain Functional Independence Measured goals. Patients work to achieve maximum outcomes in occupational/self-care activities, mobility and transfers, bowel and bladder management and psychological adjustment and wellness. An Acute Rehabilitation I patient may enter Acute Rehabilitation II to maintain continuous care and therapy to focus on wheelchair, family training and at times driving instruction. The average overall patients receive one hour each of physical therapy and occupational therapy along with recreational, speech language pathology, mental health support, vocational therapy, and a rehabilitation engineer specializing in custom assistive devices and technology as indicated.

Rehabilitation II

A Rehabilitation II patient does not meet the criteria for acute rehab. Treatment includes wheelchair and caregiver training, driver rehabilitation, and transition to home services. During Rehabilitation II, patients may receive moderate therapy to improve in some areas of functioning while reinforcing and stabilizing skills in others.

Outpatient Rehabilitation

The outpatient rehabilitation program offers a interdisciplinary therapy team with the goal of optimizing functional abilities. Interventions may include wheelchair evaluations, wheelchair training and exoskeleton therapy program.

Rehabilitation Services Includes

• SCI/D Physicians
• SCI/D Nurses
• Acute Rehabilitation Case Manager
• Occupational Therapy: Self-care and Independent Living skills
• Physical Therapy: Mobility and transfer training
• Prosthetic and/or Orthotic evaluation and training
• Rehabilitation Engineer
• Assistive Technology
• Psychological Counseling Services
• Dietician Services
• Pain Management
• Respiratory management
• Bowel or Bladder Management
• Sexuality counseling
• Communication training
• Speech Pathology
• Recreation Therapy
• Specialty Pharmacist
• Respiratory Therapy
• Chaplain Services
• Telehealth Services
• SCI/D Educational and Vocational Therapy
• Whole Health Program
• Patient, family or caregiver education and training
• Onsite consults to Radiology, Acute Medical, and Surgical Services
• Advocacy Services

I. Scope of Service

Types of Patients

All honorably discharged veterans are accepted into the program regardless of activity limitations, financial constraints, behavioral status, cultural needs, impairments, intended discharge/transition environments, and participation restrictions unless they are medically unstable and meet exclusion criteria noted elsewhere.

The types of patients served are Veterans with spinal cord injury and/or disorders from etiologies such as trauma, Multiple Sclerosis, ALS, and Guillain Barre. We service Veterans regardless of Spinal Cord Injury level including both incomplete and complete injuries.

Patients range in age from young adult to older adult.

Procedures/Services

Mission

Hines Spinal Cord Injury/Disorders Service will partner within a continuum of care with each veteran and his/her family, to optimize the veteran’s health, enhance their quality of life, and promote their independence in order to attain the Veteran’s individual goals.

Vision

Hines Spinal Cord Injury/Disorders Service will provide necessary support and understanding so that all Veterans will fully achieve their cognitive, emotional, and functional potential.

Values

SCI/D adheres to the VA’s I CARE values. These values – Integrity, Commitment, Advocacy, Respect, and Excellence – define the culture of the SCI/D service and strengthen our dedication to those we serve. 

Definition of Patient Care Services

SCI/D provides direct primary, secondary, and tertiary care for veterans in the mid-western and western USA and by referral from SCI/D Coordinators in the Hines SCI/D Catchment area. Services are provided in a collaborative interdisciplinary manner by the medical staff, registered nurses, and other health care professionals to achieve optimal outcomes. We are committed to uniform standards of care for our patients with equivalent health care needs. The program evaluates and addresses cultural and behavioral issues at the onset and during rehabilitation and beyond using specific motivational and veteran-centered strategies.

Support Services

On-site consultation, diagnostic, and treatment services include radiology, laboratory, pharmacy, assistive technology, vascular access team, audiology, dental, behavioral medicine, extensive medical and surgical consultation services (gastroenterology, neurology, neurosurgery, ophthalmology, orthopedic surgery, otolaryngology, psychiatry, pulmonary) and multiple others. Services are available on a routine or stat basis to accommodate any volume of patients in the Rehab Program. Critical findings are communicated immediately to the ordering provider. Reports and/or recommendations are typically available to the provider within 24 hours. Hines SCI/D has the capacity to provide all these services for its Inpatient Rehabilitation Program.

Payers, Funding Sources and Fees

Veterans who qualify for VA healthcare are enrolled into a medical benefits package and are assigned a priority group. Priority groups are based on Military service history, disability rating, and income levels. Veterans with service-connected disabilities are assigned the highest priority and lower priorities are assigned to Veterans who earn higher incomes and do not have service-connected disabilities. VA may bill private health insurance providers and, based on assigned priority group, Veterans may receive a co-pay for non-service-connected healthcare. All newly injured Veterans with SCI/D are evaluated for catastrophic disability upon admission and if determined eligible then they are assigned into a priority group that eliminates hospital copayment status.

Spinal Cord Home Care Program

Spinal Cord Injury/Disorders Home Care is a specialized program with resources to instruct and coordinate for the rehabilitative, social, nursing, nutritional and medical needs of spinal cord injured/impaired patients at their place of residency up to 99 miles from the facility.

The SCI/D primary care physicians make SCI/D-Home Care services available through referrals by SCI/D inpatient staff and by the SCI/D outpatient clinic nurse, as well as through high-risk case identification through the SCI/D-Home Care Case Management Service.

SCI/D Home Care Program home visits are on a scheduled and as needed basis and as determined by specific categories of care.  The team, the patient, and the patient’s family determine the purpose, frequency, and length of visitation.

Hours of Operation

Acute/Continuing & Rehabilitation Care

Bldg. 128 North and South Wards

• 24/7
• SCI/D Attending on duty 365 days a year.
• In house hospitalist service Mon – Sat including federal holidays.
• Frequency of services depends on the needs. May range from 0 hrs to 5 hrs/day. 

Administrative Offices (Chief of SCI Service)

Bldg. 128 Room A124

• 8 a.m. – 4:30 p.m.
• Monday – Friday
• Closed weekends

SCI/D Outpatient Clinic

Bldg. 128 Room A137

• 8 a.m. – 4 p.m.
• Monday – Friday
• Closed weekends

SCI/D-HC (SCI/D Home Care)

Bldg. 128 Room A129

• 7:30 a.m. – 4 p.m.
• Monday-Friday
• SCI/D Attending O.D. - Emergency calls after 4 p.m. on weekdays, weekends and federal holidays.

SCI-RCF (Residential Care Facility)

• Bldg. 221
• 24/7
• SCI/D Attending O.D. - Emergency calls  after 6 p.m., on weekends and federal holidays.

II. Access to Service

Mechanisms for Accessing Services

Inpatient admissions

Inpatient admissions are facilitated through the Chief SCI/D Office in coordination with the SCI/D Coordinator & Hospital Transfer Coordinator. Admission is coordinated after verification that the spinal cord patient is an honorably discharged Veteran of the regular US Armed Forces.

SCI/D Acute Rehabilitation

Acute Rehabilitation I program provides services for those medically stable patients able to participate. Rehabilitation therapy is provided six days a week for up to three hours a day to attain Functional Independence Measured goals. Patients work to achieve maximum outcomes in occupational/self-care activities, mobility and transfers, bowel and bladder management and psychological adjustment and wellness. An Acute Rehabilitation I patient may enter Acute Rehabilitation II to maintain continuous care and therapy to focus on wheelchair, family training, transition to home services, at times driving instruction, and continue improving some areas of functioning while reinforcing and stabilizing others. Patients receive on average one hour each of physical therapy and occupational therapy along with recreational, speech language pathology, mental health support, vocational therapy, and a rehabilitation engineer specializing in custom assistive devices and technology as indicated.

SCI/D Outpatient (OPT)

SCI/D Outpatient (OPT) appointments are handled by the SCI/D OPT Clinic which is a stand-alone clinic located in the Spinal Cord Injury Service under the direction of the Chief, SCI/D Services.  Appointments are made through the OPT Clinic receptionist.

Residential Care Facility (RCF)

Long-term care services are available and prioritized by need and service-connected status. Recommendations for admissions are requested via consult and are reviewed by RCF admission team.

SCI/D-HC (SCI/D Home Care)

SCI/D-Home Care Services are available through referrals by SCI/D inpatient staff. 

Telehealth

Telehealth appointments are facilitated through the SCI telehealth coordinator in coordination with the Chief, SCI/D services. Ongoing telehealth visits are scheduled as needed. Veteran Video Connect (VVC) encounters are scheduled to expand available options for ongoing patient encounters and care.

Respite Care

Respite care services may be provided either in home or in hospital by request to the Chief SCI/D or designee. Services are limited to 30 calendar days per year.

Frequency of Services

As noted above, Veterans with spinal cord injury are eligible for treatment based on medical necessity. Some receive daily or weekly interventions while others are treated monthly. Providers collaborate with patients while scheduling appointments.

III. Goals of Department / Service

Goals

The goal of the SCI/D team is to maximize levels of independence, quality of life and productivity through treatment, training and education which will enable the patient to live as independently as possible in an appropriate setting outside of the hospital that reflects their current functional levels at discharge and throughout their lifespan. 

This is achieved through our comprehensive inpatient rehabilitation program, annual evaluation protocols and long-term outpatient management. In order to meet the unique aspects of delivering care to individuals with SCI/D, we offer services in the following areas:

1. Medical/physiological sequalae: (including assessment/intervention on abnormal tone/spasticity management, autonomic dysfunction, bladder/bowel function, body composition (i.e., ideal body weight calculation), circulation, dysphagia, fertility, infection management, medication, men’s and women’s specific health issues, musculoskeletal complications, neurological changes, nutrition, pain, respiration, sexual function, skin integrity, and ventilation support).
2. Functional:  (including assessment/intervention for activities of daily living, independent living, assistive technology, behavior, cognition, communication, community integration, driving, durable medical equipment, emergency preparedness, environmental modifications, leisure and recreation, mobility, occupation, orthoses, personal care assistants, prostheses, and seating).
3. Psychosocial  (including assessment/intervention on adjustment to disability, behavioral health, substance use, family/support counseling, peer support services, and sexual adjustment).
4. Education and Training: (including persons served, families/support systems, the community, and the professional community).
5. Transitions across the Lifespan 
6. Case Management/Resource Management
7. Health Promotion and Wellness (e.g., SCI/D Academy, Whole Health Program. KT Outpatient Program, vocational, and employment services)
8. Safety Management (including local and community involvement, and discharge environments)
9. Prevention (e.g., pressure ulcer prevention education, immunization monitoring)
10. Follow-up (e.g., 90-day rehab f/u evaluation, annual evaluation process) 

The overall goal of the SCI/D Home Care Program is to enhance, through a facilitating process, the independent functioning of the veterans with SCI/D in the community.  Services are based on an individual treatment plan determined by patient needs. 

IV. Plan to Improve Quality of Service

Performance Improvement Priorities - Aspects of Care High Volume, High Risk, Problem Prone

SCI/D rehabilitation program will meet the expected level of performance of the following indicators:

• Length of Rehabilitation Stay
• Unplanned transfers
• Neurologic deterioration
• Deaths during rehabilitation
• Co-morbidities at admission
• Co-morbidities at discharge
• Achievement of projected FIM Goal
• Decrease number of nosocomial ulcers
• Increase patient satisfaction as rated very good or excellent
• Meet or exceed the levels of beds and staffing at each SCI/D Center specified in the VHA Directive specified in VHA directive 2008-085.
• Evaluate the appropriateness and effectiveness of fall management in the SCI/D Home Care Program
• Increase patient involvement/goal setting utilizing Motivational Interviewing (MI) techniques

Information Dissemination - SCI/D Website

To provide relevant information on characteristics-, satisfaction-, and numbers- of persons served yearly, average number of visits per service, treatment disposition and efficacy, and unplanned disruptions to patients, families/caregivers, referral sources, payers, other stakeholders (including Paralyzed Veterans of America), and the general public, we provide the information to the hospital’s webmaster for dissemination on Hines SCI/D website and other social media platforms to encourage access. It is generally compiled by the SCI/D staff in January-February covering the prior fiscal year. National VA-mandated statistics continue to be updated and posted around the unit.

V.  Department Specific Standards

Standards

• CARF & The Joint Commission Standards for efficiency, effectiveness. and satisfaction indicators.
• The Department of Veterans Affairs VHA Handbook 1176.1 & 1106.

• Standards of Care Measures for SCI Veterans

   

VI. Staffing

Staffing Plan

SCI/D staff is a multidisciplinary staff with members from Nursing, Social Work, Psychology, Psychiatry, Vocational Rehabilitation Therapy, Recreational Therapy, General Surgery, Physical Medicine & Rehabilitation, Nutrition, Speech & Swallow Therapy, Assistive Technology, Pharmacy, Urology, Neurology, Otolaryngology, Neurosurgery, Orthopedics, Plastic Surgery,  Performance Improvement/Quality Assurance, Infectious Disease, Wound Care, Palliative Care, Chaplain Services, and other relevant subspecialties.

Collaborative / Functional Relationships with Other Departments and Services 

In addition to the above-mentioned services/departments (as well as collaboration with prosthetics department), the SCI/D Service actively participates and promotes research to benefit SCI/D Veterans, as well as patients in the general population.

Some recent research collaborators include: the Department of Defense (DOD), Marquette University, Shriners Hospitals for Children, the Shirley Ryan Ability Lab (formally known as the Rehabilitation Institute of Chicago (RIC), Rush University Medical Center, Schwab Rehabilitation Hospital, the Craig H. Neilsen foundation, and Christopher & Dana Reeve Foundation. 

The SCI/D Outpatient clinic provides continuity of care after inpatient discharge with the ultimate goal of assisting people to achieve a healthy lifestyle. The outpatient clinic serves the important function of performing comprehensive preventive annual physical exams in person and through VA Video Connect (VVC) Telemedicine for the veterans enrolled in our program. We provide comprehensive medical care for Veterans with Spinal Cord Injuries including spinal cord disorders caused by Multiple Sclerosis. The clinic offers prevention and treatment of pressure ulcers, chronic pain management, spasticity treatments including Botox and baclofen pump medical management. We offer psychological support for life stressors and/or adjustment to SCI/D.  

The SCI/D Outpatient clinic is staffed with certified physicians, psychologists, nurse practitioners, registered nurses, social workers, therapists, dietician, health care technician, and a medical support assistant. The clinic provides EKG, bladder scans, tele-retinal examinations, and screening for diabetics.

The clinic offers preventative care such as immunizations, smoking cessation referrals, and weight management. Individualized care is provided to Veterans including education on the causes and management of autonomic dysreflexia. The clinic also provides Wellness Visits through VVC. 

The SCI/D Home Care provides ongoing in-home continuity of care and monitoring of the newly injured, as well as established Veterans at risk for additional medical problems. SCI/D Home Care staff help Veterans and family members make a smooth and effective transition from hospital to the community.

The SCI/D Home Care interdisciplinary team members provide collaborative clinical care services such as skilled nursing, care management, psychosocial, rehabilitative, nutritional support, and skin and wound evaluation/management to improve quality of life. Each Veteran will have a designated primary physician, nurse, and social worker. 

  Home care staff conduct home evaluations to address issues with safety and accessibility. In addition to Veterans enrolled in the home care program, home care staff also monitors SCI/D Veterans residing in community nursing homes. 

The SCI/D Community Living Center is also known as the SCI Residential Care Facility (RCF)  is a 30-bed residential long-term care facility especially designed and staffed for Veterans with spinal cord injury and associated disorders. The facility is located on Edward Hines VA Hospital Campus.

The center offers residency to Veterans with SCI/D in a community-based care setting.  The ongoing focus of the RCF is to provide an active, social community system for maximum enhancement of functional and supportive resources. Residents are encouraged to participate fully in available activities including recreational and gainful endeavors.

Every Resident is under the medical care of an Attending Physician who is a member of the Hines VA Hospital Spinal Cord Injury staff.  Your Attending Physician collaborates with the Nurse Practitioner and nursing staff in planning your healthcare.  Additional on-unit staff services include social work, psychology, physical therapy, occupational therapy, kinesiotherapy, and educational and recreational therapy; a dietician and pharmacist are also involved on the team. 

Other services often important to a Veteran with SCI/D such as speech, psychiatry, urology, neurology, and surgery among others, are available through in-house consultations.

The admission process entails a consult from a Veteran’s primary care attending requesting admission. Our multidisciplinary team will then review the Veteran’s chart for medical appropriateness and fit for community living.  Given the focus on community living, we are unfortunately unable to offer hospice and respite care as well as care for Veterans requiring respiratory ventilation at this time. 

Our Goals 

We are committed to a holistic approach to those in need of healthcare. 

• To restore, maintain, and promote health and functional ability.
• To minimize the physical, psychological, and emotional effects of disability on both the Resident and the family.
• To provide a stimulating climate of motivation and expectancy which fosters maximum self-care and satisfaction of daily living for each Resident.
• To promote healthcare ranging from an active rehabilitation program to a maintenance supportive program.