CARF International launched new standards in 2026 for the Disorders of Consciousness (DoC) Specialty Program, aiming to make rehab more accessible for people dealing with conditions like coma, vegetative or minimally conscious states, and other brain injuries. The focus is on putting individuals and their families at the center of care and making sure specialized rehab is available when needed. The new DoC program standards are found in the Medical Rehabilitation section of the Standards.
A Little DoC History
Our designation of consciousness has been in place since Aristotle, when in 400 B.C., descriptions of coma were written. Modern development occurred in 1972 when Scottish neurosurgeon Bryan Jennett and American neurologist Fred Plum published in Lancet, “Persistent Vegetative State After Brain Damage,” introducing the term and defining the condition as a state of “wakefulness without awareness.”
The vegetative state was further defined in 1994 in an American Academy of Neurology report defining persistent and permanent vegetative states. In 2002, a diagnostic boundary was introduced to define the Minimally Conscious State to distinguish it from the vegetative state. The European Task Force on DoC suggested replacing “vegetative state” with Unresponsive Wakefulness Syndrome (UWS) to reduce the stigma associated with the term “vegetative.”
Rising Numbers
Terrence Carolan, Managing Director at CARF International, explains that recent research highlights how important it is to have specialized teams with the right skills to help this unique group. With these new guidelines from the American College of Surgeons and the American Congress of Rehabilitation Medicine, DoC cases are expected to rise. These guidelines direct clinicians to not give up aggressive care too soon after a TBI diagnosis: instead, doctors should wait at least 28 days to get a better sense of the patient’s prognosis because some who don’t wake up quickly can still have meaningful recoveries.
The rationale for these standards is simple—over 150 DoC programs exist in hospitals, nursing facilities, and long-term care centers across the U.S., Canada, and internationally. But many healthcare providers don’t know much about DoC or struggle to recognize it. As awareness, diagnosis, and treatment improve, so will the number of people who need help. In addition, a CARF consultant can assist an organization in seeking accreditation.
To set up these CARF standards, a CARF accreditation advisory team spent a year gathering feedback from stakeholders, including families, looking at trends in rehab, and digging into recent studies. This work led to creating peer-led accreditation surveys based on the Medical Rehabilitation Standards Manual.
Key features of a DoC specialty program:
- Streamlined pre-admission procedures, for appropriate referrals and family involvement.
- Admission based on clinical needs.
- A transdisciplinary approach.
- Family and support center consults in decisions, plus education and support as patients’ conditions change.
- Focused training for staff on caring for people with DoC, and ongoing support for staff well-being.
- Advocacy for both patients and their families.
- Showing real commitment and providing resources for DoC patients.
The process for creating these standards included input from CARF International Standards Advisory Committee and feedback from experts and the public, including individuals and families affected by DoC. The 2026 Medical Rehabilitation Standards Manual, featuring these updates, goes live July 1, 2026.
Carolan sums it up: this effort is all about boosting awareness, improving access to rehab, and advocating for better care. There’s a gap in specialized services for DoC, and CARF hopes these standards will help bridge it.
If you or an associated facility is interested in CARF consulting for a DoC Specialty Program CARF accreditation, please contact Kevin Robertson, PowderHorn Consulting, at krobert6@san.rr.com
- Q: What are the new CARF standards for the Disorders of Consciousness (DoC) Specialty Program designed to achieve?
A: The new CARF standards for the Disorders of Consciousness Specialty Program aim to make rehabilitation more accessible for individuals with conditions such as coma, vegetative or minimally conscious states, and other brain injuries. These standards focus on person-centered care that supports both patients and their families, ensuring specialized rehabilitation services are available when needed. The DoC program standards are included in the Medical Rehabilitation section of the CARF Standards Manual.
- Q: What are some key features of a DoC specialty program according to the new CARF standards?
A: Key features of a DoC specialty program include streamlined pre-admission procedures with family involvement, admission based on clinical needs, a transdisciplinary approach, family consultations and support as conditions change, specialized staff training and ongoing staff well-being, advocacy for patients and families, and a demonstrated commitment to providing resources for DoC patients.
- Q: How were the new DoC standards developed, and when do they go into effect?
A: CARF developed the new DoC standards by gathering input from its International Standards Advisory Committee, seeking feedback from experts, affected individuals, and families, and conducting public reviews. The updated standards are included in the 2026 Medical Rehabilitation Standards Manual and will go into effect on July 1, 2026.
