ABI Waiver Eligibility in Connecticut: Are Two ADLs Still Enough?
As Connecticut continues to see a rise in the number of individuals living with complex traumatic brain injuries (TBI) and other acquired brain injuries, an important question is emerging for families, providers, and policymakers alike:
Is the current acceptance criteria for the ABI Waiver still an accurate reflection of real-world need?
At The Supported Living Group (SLG), we work daily with brain injury survivors across Connecticut. Increasingly, we see individuals whose needs are profound, ongoing, and life-altering—yet who struggle to access long-term supports because their impairments do not fit neatly into traditional eligibility frameworks.
Understanding the ABI Waiver in Connecticut
The Acquired Brain Injury (ABI) Waiver is designed to support individuals who have sustained a brain injury and require long-term, community-based services to remain safely in their homes and communities rather than in institutional settings.
To qualify, individuals must generally meet criteria related to:
A documented acquired brain injury
Nursing facility or institutional level of care
Functional limitations, often measured through Activities of Daily Living (ADLs)
Historically, demonstrating the need for assistance with two or more ADLs has been a central gateway to accessing ABI Waiver services.
The Problem With an ADL-Driven Model
ADLs, such as bathing, dressing, toileting, or transferring, are concrete and easily observable. They work well for identifying physical dependency. However, brain injury does not always present as a physical disability.
Many individuals with moderate to severe TBI can physically complete ADLs, yet still experience:
Significant executive functioning impairments
Poor judgment and safety awareness
Reduced initiation and task follow-through
Emotional dysregulation and behavioral challenges
Memory and attention deficits that compromise independence
From a neuropsychological perspective, these impairments can be far more disabling than the inability to perform an ADL independently, yet they often go underrecognized during eligibility determinations.
Rising Complexity of TBI in Connecticut
Across Connecticut, providers are seeing a growing population of individuals with:
Multiple brain injuries over time
Co-occurring mental health conditions
Substance use histories
Aging-related cognitive decline layered on top of ABI
Social isolation and fractured support systems
These individuals may not need hands-on help with bathing or dressing, but they do require consistent structure, cueing, supervision, and behavioral support to remain safe and stable in the community.
When access to long-term services hinges primarily on ADL deficits, many people with complex TBI are left without appropriate support until a crisis occurs.
Is Two ADLs Still a Meaningful Threshold?
As the ABI population evolves, it is reasonable and necessary to question whether requiring assistance with two ADLs remains a sufficient or appropriate measure of need.
This standard may:
Exclude individuals with significant cognitive and behavioral impairment
Push families to manage unsafe situations without support
Funnel survivors into ill-fitting programs not designed for ABI
Mask the true scope of the brain injury need in Connecticut
In practice, we often see individuals access services only after a preventable hospitalization, institutional placement, or legal involvement, outcomes the ABI Waiver was originally designed to avoid.
The Case for a More Brain Injury–Informed Assessment
A modern approach to ABI Waiver eligibility should more fully account for:
Executive functioning and decision-making capacity
Safety awareness and risk assessment
Ability to initiate, sequence, and complete daily tasks
Behavioral regulation and emotional control
The cumulative impact of brain injury over time
These factors are well-established in neuropsychology and brain injury rehabilitation, yet they remain inconsistently weighted in long-term care determinations.
The Supported Living Group: Leaders in ABI Services in Connecticut
For decades, The Supported Living Group has been a leader in non-medical, community-based brain injury services in Connecticut. We specialize in supporting individuals whose needs extend beyond physical careand into the cognitive, behavioral, and functional realities of life after brain injury.
Our programs are informed by:
Deep expertise in ABI and TBI support
Internal clinical leadership, including neuropsychological and occupational therapy perspectives
A commitment to keeping individuals safely in the communities of their choice
Ongoing advocacy for systems that reflect the true lived experience of brain injury survivors
Families, professionals, and referral sources across Connecticut rely on SLG as a trusted source of brain injury information, guidance, and support.
Looking Forward
As Connecticut’s brain injury population grows more complex, eligibility standards must evolve accordingly. Two ADLs alone may no longer tell the full story.
At The Supported Living Group, we believe that access to long-term ABI supports should reflect how people actually live, struggle, and function—not just what can be checked off on an assessment form.
If you are navigating the ABI Waiver process, supporting a loved one with a brain injury, or seeking expert guidance on brain injury services in Connecticut, SLG is here to help.
Contact The Supported Living Group to learn more about ABI services, waiver navigation, and brain injury–informed community supports across Connecticut.