Program gives patients new lease on life

Day rehab clients package gift baskets

Brain injury clients at MossRehab's day treatment program are getting a chance to learn new job skills and earn a paycheck by participating in a new program that is expected to eventually pay its own way.

The Philadelphia rehabilitation provider, part of Albert Einstein Healthcare Network, has started Nifty Gifts, a non-profit gift-service business that helps survivors of brain injury build competitive job skills. Patients in the program initially came from MossRehab's post-acute program.

The gift service operates in conjunction with MossRehab's Clubhouse, a community-based day program for brain injury survivors.

Nifty Gifts opened its doors in November 1997, with seed money from two local foundations.

"The idea is that the business will gradually be able to support itself through sales revenue. When we go beyond breaking even, we can use the excess revenue to support other underfunded post acute programs," says Drew Nagele, PsyD, clinical director, ambulatory programs at MossRehab and director of Nifty Gifts.

The gift baskets, which are competitively priced, with a profit built in, are designed by Bobbi Townsend, business manager for Nifty Gifts, who has more than 25 years of experience in retail gift sales.

An advisory committee of community volunteers with experience in various types of businesses helps select the products that will be offered for sale.

"We try to provide items that are of very high quality and that are not readily available in the local marketplace," Townsend says.

Employees at Nifty Gifts assemble and package gifts, conduct telephone sales, manage inventory, and set up delivery of the gift baskets.

The program has five permanent employees. The work force swells to 10 to 12 for holidays and special events.

Participants are paid an hourly wage commensurate with what they would receive for similar work at commercial firms in the area.

The program hires people with disabilities and some without disabilities to provide a heterogenous working environment like that of any other company.

Clubhouse participants may start out as volunteers at Nifty Gifts, gaining the skills they need to move up to employees.

Employees start out at Nifty Gifts being assisted by a job coach who helps them develop strategies to overcome the deficits caused by their brain injury and to be successful in the job. Once the strategies are in place, the job coach fades out of the picture.

After employee work for six months to a year at Nifty Gifts, the rehab staff will help them find a similar job in the private sector, such as working in shipping and receiving at a local business or assembly work at another gift company.

Initially, the employees have all come from MossRehab's post acute brain injury programs. However, in the future, Nagele anticipates that other local brain injury programs may place clients at Nifty Gifts.

Treated like regular staff

The workers are employees of MossRehab and get a paycheck every other week just like the regular staff.

So far, all of the employees have been hired for part-time work.

"This is partly because the business is just starting up but also in response to the needs of people who go to work after brain injury. Their disability determines their ability to work, and many cannot put in a full day at work," Nagele says.

Nifty Gifts employees and participants in the Clubhouse Program handle direct mail advertising to the consumer market.

The rehab staff and some members of the volunteer advisory board call on local corporations to make them aware of the gift baskets and the opportunities to hire people who are finishing the program.

The Nifty Gifts are sold primarily through mail and telephone orders and delivered by commercial carriers.

For Valentine's Day, the center operated four cash-and-carry booths for direct sales of the products.

They sold mugs filled with candy, stuffed teddy bears carrying a heart shaped lollipop or box of candy, a "Dinner for Two" basket with pasta sauce, pasta, bread sticks, and wine glasses; and "Sweets for the Sweets," a basket filled with candy, cookies, and nuts.

Other popular baskets include "Sunday Brunch," a selection of gourmet pancake mixes and syrups, and "Some Like it Hot," a basket filled with chili mixes, salsa, mustards, and barbecue sauces.

[Editor's note: For more information on the Nifty Gifts program, call (888) 440-1400.]

DeMaria PL, Gertzen J, Weinstein RA. Nosocomial infections in human immunodeficiency virus-infected patients in a long-term-care setting. Clin Infect Dis 1997; 25:1,230-1,232.

Rates of hospital-acquired infections were high among HIV-infected patients in a long-term care setting, with many patients infected with common nosocomial bacteria and infections overall contributing to a significant number of deaths, the authors report.

Because patients with AIDS are living longer, it is expected that more of them will require long-term care, and nosocomial infections will probably contribute to an increase in morbidity, mortality, and cost of care. In addition, the occurrence of antibiotic-resistant bacteria is likely to be a problem in such a high-risk population.

Rate of infection studied

For 13 months, researchers observed HIV-infected patients (50 men and 15 women) in a dedicated 21-bed unit in a long-term-care facility to determine the rate of nosocomial infections. The mean age of the patients was 39 years (range, 22-78 years); 74% of the patients had CD4 cell counts of <200/mm 3. There was a total of 152 infections (24 infections per 1,000 long-term-care days). The factors associated with the occurrence of a nosocomial infection were low CD4 cell counts, poor functional status, and longer duration of stays at the facility. The three most common infections were Clostridium difficile-associated diarrhea, primary bacteremia, and urinary tract infection. More than 50% of the cases of bacteremia were due to multidrug-resistant organisms.

Patients with HIV infection who require long-term subacute nursing care have many risk factors for infection including immunosuppression, the presence of invasive devices, and the use of antibiotics. The mortality rate among patients on the unit was high (52%), but this finding was not unexpected given that many of the patients were referred for terminal care, the authors noted. Infections contributed to more than 40% of the deaths.