A report is usually written to justify funding request for support recommendations. These cannot be done quickly and can be considered malpractice when inappropriate recommendations are made and the person is injured unnecessarily.

Going home with a new cognitive disability is a shock to most people who have never been around anyone with a similar condition. "You'll be fine when we get home" is wishful thinking and can provide a sense of false hope. Help and advice that was refused in the hospital is greeted with a hundred questions one or two weeks later. Most people need time to recognize the reality of a cognitive disability because the problem is not visible until after two or three weeks.

The person with a cognitive disability is dependent on other people to provide the actions and activities that they can do while supervised:

• Avoids steps that they cannot do.
• Adapts contents, steps or supplies to meet their obsolete identities.
• Prevents accidents or injuries.

Their dependency on other people adds the caregiver's needs into necessary considerations. Long-term caregivers are depended on to set-up, direct, and supervise the actions or activities. Their efforts need to make sense to them too. An appreciation for the value of doing enjoyable actions and activities is best developed by watching an expert demonstrate how to do it and identifying with the person's pleasure. When you demonstrate, have them observe the person first and then teach them the details about the set-up. The goal is pleasure in doing something.

A safe and effective activity plan only works right when the methods are tailored to fit the cognitively disabled person into the complexities of real life. The necessary modifications are identified in the familiar biopsychosocial framework.

Ideally, discharge recommendations and program planning should be based on evidence based predictions about patterns of activity performance in another setting. The data gathered should be based on standards of practice, with measurements that you trust to generalize from one location to another and from one action or activity to another. To meet those ideals, you need to know what you are supposed to do during the treatment process.

To set up and sustain actions or activities that the person enjoys doing for months and years, the following process is recommended:

Effective actions or activities arouse and sustain the attention of the cognitively disabled person, make good sense to the person and are accepted as positive by other people.

The ability to produce activities which the person chooses to participate in takes skills and creativity. This skill is appreciated by the person and their caregivers because when the person is happily occupied they are not causing problems. The person with a cognitive disability does not perceive the negative consequences and the hurt feelings of other people.

People need to be accepted as they are and recognized for what they can enjoy doing now. Plans also need to include their dependence on other people for compensatory support for things which they cannot manage. Skill and creative knowledge is required to provide activities which they can do that maintains their sense of being respected as a human being.

Some people will accept a lifelong cognitive disability and collaborate to plan for adjustments in their lifestyle. Accepting grim realities may be necessary but it is not easy. Those who do, appreciate educational information, but are vulnerable to exaggerated claims of predictive validity. Human behavior has lots of inconsistencies such as past training and habits. This over-exaggeration may make the ACLs vulnerable to abuse.

The comprehensive effects of a cognitive disability are not observable until people stop talking. Within ACL 3 Low, denial is no longer possible because these people cannot say much. Above ACL 3 High, the whole world has been denying the comprehensive effects for centuries. As you provide educational information, you can expect the phrase "to shoot the messenger" to acquire personal meaning. The reality is grim. Period.