Not for Profit May Provide Better Care
Summary: Rachel, Rachel, Where's your progress.
Place you're at is all for profit.
You had some strokes,
Have to relearn talking,
Swallowing, walking, get strength back.
Client, or patient? Which suggests autonomy. Where are best results for the client found: at for-profit, or not-for-profit facilities.
But one side's still atrophied and shriveled.
She's not "old." Where's the brain-retraining rehab.
Instead, tummy tube's in,
Cheaper than staffing.
Rachel, Rachel, you've been had.
Atrophy? How to get back movement.
Anger, act out? They say nix.
We like you quiet, supplicating.
We're here for shareholders.
NYT: Health Care and Profits
A Poor Mix
Would an aide-type category of trained stroke coach there with the client daily not only provide jobs, but enable stroke clients to receive ongoing stimulation, exercise, progress measured. Sedation? Hard for an outsider to tell, but there are such strong swings of emotion and anger vs. passivity, that the question should be asked.
When can the client be told her medical and financial realities. The institutional doctor, with perhaps an interest in serving the financial need of the institution and a paying customer; or a doctor dedicated to the client's recovery or autonomy as far as medically feasible.
3.2 Consider not-for-profit Magnet Stroke Centers.
Leave the for-profits where rehabilitation and improvement are so far out of the picture that it is reasonable to keep people fed and clean and quiet until they die.
How much per day for a bed in a double, little if no added services, a doctor looking only at records, is there any hands on at all? Perhaps there is. Compare that to at-home care once the emergency is past. Or, compare to costs at a really focused rehab -- even if not at the Gabby Giffords or Warren Buffett level.
Clearly, this stems from a recent experience with a dear friend. Get me out of here. As the words became clearer, there they come again. I want to go home. Please get me home. And depression, etc.
Stimulation, progress. Or do we put our handicapped like orphans in those sad orphanages pictured not so long ago, clean, fed, but foetal..
6. Autonomy and self-determination.
Even if a feeding tube is needed, how did it get that way? Was this stroke client given eating, swallowing rehab? Why not. She needs brain retraining. Once in, how to wean her off so she could at least regain some going out. Even in the institution's medical van, for some stimulation.
Adults deserve individualized, equal attention so less is needed of others down the road. It is economically in the national interest.
7. HIPAA. What parts of HIPAA can still support a sharing of some health information.
Noone on the outside gets health information. Fine. But who calls in the ombudsman? Without set times to reconsider competence, HIPAA it leads also to the ability to shield how decisions are made. This nursing home is lovely, kindly, and does the maintenance that Rachel's people pay for, or Medicare and eventually Medicaid will, probably. Look at the lashing out against whistle-blowers anywhere. In a small community, how to dare to call the ombudsman when the children won't. Get lawyers involved? No way. There goes the estate, is that so. See federal privacy rules, see summary at http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html.
8. Back to stroke coach. Job opportunity, occupational assist. Ombudsman on the spot.
9. Retraining equipment for learning to write with the left hand, speak, get some stimulation. Touchpads. Screen-technology -- Add a few notebooks, iPads, at the desk, and see who can learn. Some kind of non-tangling earphone for quiet, personalized TV.