Progress Unlimited is a nonprofit organization located in Owings Mills, Maryland that provides residential and medical day programs for adults with developmental disabilities. The medical day program serves about 93 individuals and provides two meals, nursing care, therapies, activities and transportation five days a week from 8am to 4pm. Clients have various physical, intellectual and developmental disabilities and chronic health conditions. The program coordinates services between physicians, health care providers and community resources to promote clients' health and independence. Caring for clients presents challenges in communication, emergency care, and medication administration due to clients' disabilities.

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Progress Unlimited- Medical Day Program
Mofoluke Sobowale

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Progress Unlimited Inc ( PUI ) is a non profit organization that provides residential and a
medical day center. It is located on Cronhill drive off Owings mills boulevard in Owings Mills,
Maryland. The medical day center was established in 2007 providing and opens from 8am –
4pm five days a week caring for about 93 individuals. It provides “care and support to adults
with developmental disabilities which allows individuals to live independently in their
communities with assistance from support staff in each home” ( www. Progressunlimited.org
2014). Owings Mills boulevard is a stretch of road with different business establishments which
continues on Cronhill drive. The community where Progress Unlimited is located is clean and
well kept. There are no signs of residential homes or animals, and there are minimal people
walking on the sidewalk at any given time of the day except during lunch time. The landscape in
the community is very luscious with planted trees, scrubs, and plants around the boundaries of all
the establishment and along the street. The building housing Progress Unlimited is a ranch brick
style building with glass entry doors and about five steps with rails leading to the front door.
Progress Unlimited serves individual with different types of developmental, intellectual,
and physical disabilities, who are “eligible without regard to race, color, sexual orientation or
national origin; services for individuals are funded through medical assistance which is
determined by the Baltimore County Adult eligibility review services” (progressunlimited,
2014). Acceptance to the organization could be for either residential and medical day program or
both depending on individual choice, needs and funds. The center provides a variety of services
to the clients’ which is based on individualized clinical assessment and care plan, consultation
with physicians providing care and other health care providers. One of the services the center
provides is transportation to and from the center. Individuals are transported from residential

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areas within Baltimore county, mostly in Owings mills, Randallstown, and Pikesville with 3
clients per house. Clients arrive at the center between 8:30 and 9:30am, two nutritionally
balanced meals are provided daily. Breakfast when they arrive at the center, snacks, beverages,
and lunch around 11:30- 12noon. About 70% of the clients need assistance with feeding while
30% can feed themselves. Meals are prepared on site and accommodations are made for special
diets such as low sugar, low salt, low cholesterol, chopped, pureed or soft diet depending on the
client’s dietary needs. Clients receive medical management including medication and nursing
care as prescribed or as needed. The day care center is staffed by licensed and unlicensed staff
with the ratio of 1 unlicensed staff to 6 clients with various capabilities. Majority of the clients
are totally dependent on staff for activities of daily living including toileting or changing which
is completed every two hours or as needed. Some other services provided include physiotherapy
twice a week focusing on exercise , gait training and manual therapy, occupational therapy,
podiatry, sensory stimulation, case management. Clients are also involved in social activities
such as sport trips, field trips, cookouts, and recreational activities including art and craft, vocal
and instrumental arts, horticultural activities. Clients also enjoy services such as beauty care and
massage therapy.
Clients attending Progress Unlimited are a combination of clients from other
organizations. The clients from these organizations make up the residents in the residential
program, and attend the medical day program. These number of clients per organizations include
Active Day (2), Athelas Autism program (4), Athelas Institute (13), The Arc of Baltimore
Woodlawn center (2), The Arc of Baltimore (4), Change Inc (1), Chimes liberty club (4), Family
Service foundation (2), Francis and Gallagher (2), and Intervals (3). Client’s are admitted into
the Day care program through different avenues, according to the manager of the center, “ family

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members decide if the client requires community based program either residential, the day
program or both and the clients do not have to be in the Developmental Disabilities
Administration (DDA) program to be eligible for community services. Clients can be admitted
from a hospital or nursing home. Most clients live in the community and each home is assigned a
house manager, an On-call registered nurse and 24 hour unlicensed staff (Manager, Personal
communication 2014 ), 3 program coordinators, and 2 psychology associates. The community of
clients at the center are a diverse group of Caucasians and African Americans amongst the
clients, about 80% at the center use a power and manual wheelchair, 10% use a supportive
device and 10% can walk with or without assistance. Some of the clients attend the center 3-5
days a week and religious affiliations include Baptist, Jewish, and Protestant denominations.
The strength of the Progress Unlimited is based on the coordination of services between
different physicians and health care providers. Due to diverse developmental, intellectual, and
physical disabilities, with conditions such as cerebral palsy, Down’s syndrome, quadriplegia,
paraplegia, epileptic seizures, visual, hearing or speech impairment, multiple sclerosis, head
injury, neurological or orthopedic impairment and mental illness. Clients receive care from
different specialists including occupational, and physiotherapy, speech therapy, specialized
medical care, behavioral support service, counseling, psychiatry treatment and sign language
specialist. These services are coordinated in the community by the appropriate health
departments and implemented between the residential and medical day program. These strengths
outweigh the weakness of final eligibility which is made within “60 days after the initial
notification for eligibility that is confirmed by the DDA” (www. dda.dhmh.maryland.gov, 2014).
The state of health of clients at Progress Unlimited is healthy due to health maintenance,
health promotion and disease prevention. Client “information and counseling for health

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promoting behaviors is important and for prevention of the progression of a condition or
pathology” ( Stanhope & Lancaster, 2012, P.708 ). 80% of clients have a combination of chronic
illnesses apart from the developmental disability. Stanhope and Lancaster (2012) stated that
“persons with disabilities may be at greater risk for developing illnesses as a result of their
conditions due to decreased mobility, such as skin breakdown, osteoporosis, pneumonia,
malnutrition, or loneliness” ( p.703). Clients at Progress unlimited had chronic illnesses such as
diabetes, hyperlipidemia, high blood pressure, seizures, tardive dyskinesia, urinary tract
infections, urinary retention, crohn’s disease, cardiac diseases, microcephaly, hydrocephaly,
dysphagia, spino cerebellar disease, and multiple joint contractures. This conditions are included
in the client’s nursing care plan and their health is maintained incorporating recommendations
from their healthcare provider and using resources such as a medication regime, monthly vital
sign and weight evaluations, dietary regime, drug toxicity monitoring, range and motion
exercises, and aspiration precautions.
Caring for clients at Progress Unlimited has its challenges, one of the challenges include
finding out what the clients’ complaints are, because most clients cannot communicate or
communication is unclear. As a Community health nurse (CHN) being educated about the
client’s conditions is very important, education includes building a good relationship with the
client, residential staff and family members. The CHN while completing the client’s assessment
incorporates the primary care giver or history from the family members, and residential staff
about the best way to interact with the clients and meaning of gestures or certain words.
According to Ms P. Johnson (preceptor), another challenge clients experience is “difficulties
during emergency care, emergency personnel may experience difficulty in assessing and
determining a health issue” (personal communication, July 3, 2014). The CHN in this situation

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sends written documentation and an aide with the client, and communicates directly with the
emergency care providers, also the collaboration with the main care provider helps to alleviate
misunderstandings. Administration of medication is a challenge among these clients, some due
to physical anomalies affecting the mouth, dysphagia and developmental disabilities. Medication
are either given in liquid form, crushed in apple sauce or pudding. Some administered via enteral
feeding or orally. Every client’s unique style has to be understood in order to accomplish
medication administration.
Caring for clients at Progress Unlimited has its challenges due to the different needs of
clients with developmental, intellectual and physical disabilities. But education, collaboration
with other community providers, advocacy and case management and resources in the
community helps clients to live as normal a life as possible in a safe and caring environment.

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References
Department of Mental Health and Hygiene. Developmental disability administration (2014),
Retrieved from dda.dhmh.maryland.gov
Progess Unlimited Inc. (2012) Retrieved from www.progressunlimited.org
Stanhope,M., & Lancaster, J., (2012). Public health nursing: Population centered health care in
the community ( 8th ed. ) Missouri, Elsevier.

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