Wednesday, January 9, 2013

Need for Stroke Coach. HIPAA and Stroke Autonomy. The Wheelchaired. Are We Patients or Clients, Turned into Stroke Victims, Stroke "Patients." Post-Stroke Stimulation, Post-Stroke Development Plans Needed; Not Just Maintenance

Update January 2013.
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,
Sedation suspected.
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


Can we focus on needs of stroke, and get out some stats on improvement likelihood:  for-profit institution; or for-profit.  Capitalism says keep costs down, increase profits for shareholders.  At what point do we turn that down, and can we. What do people do when there is noone at home to care for them.  It is inspiring to see what consistent loving attention can do.  See this image, gone viral, with the elderly husband teaching his stroke-hit wife, to read again, to move,  http://imgur.com/gallery/1Y1xF.  No mere nursing home does that without paying a fortune.

First, patients get nowhere.  Even the term is passive. If patients were recognized as the clients instead, with fiduciary duty to the client, then results could be the measure of whether the professional should be paid. Wheelchaired people?  Easier to control. Are we surprised that the aim is to get and keep people there. Thank you, oh, thank you.

Research needed, and the New York Times article is a good start.  Does for-profit make the difference between offering more staffing so rehabilitation can succeed; and mere food and shelter. We need a job-care category.   Stroke Coach. And an in-house but independent ombudsman. 

1.  Medical clients:  not patients. Clarify who is the driver:  the institution and its profits, or the client's reasonable needs.

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.


2.  Powers of attorney.  In the crisis, this power is freely given out.  Who determines when the client is able to resume decision-making, and in what areas.  When does her money stop being her money.  Some people have brain areas that can be retrained.  Who looks out for that? Who watches for the regaining of competence.

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.  Rachel.  A vital, bright, feisty autonomous woman, after all is gone, taken: her own decision-making let go.
Did it have to be, to that extent? What shall we call her?  We cannot call her by her name.

3.1  Why wasn't a goal to enable her to at least stand up, eventually use a walker? Why has her limp side atrophied in care, instead of improved.

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.
4.  Cost-Benefit analysis of alternatives for the client and others to consider.

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.  

5.  Best interests where persons can be brought to higher degrees of functioning.  Who decides when we give up. A single CAT scan during the emergency?

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.
Does the tube arrangement make leaving easier or harder?

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.

Wednesday, January 2, 2013

Mika Week. Anchor Rotation Devoutly to be Wished


Mika, Mika, I've been thinking
What a fine world this would be,
If the menfolk oblivious around thee
Had to pay attention for a week. *

Trompe News.  MSNBC announces anchor rotations for Morning Joe, finally setting aside Old Joe Himself one full week per month, and installing Mika Brzezynski as ank. She may choose her own week. In addition, for seven days prior to and immediately after any federal election, Ms. Brzezynski shall also ank. She shall select her guests and topics. The immediate response of the viewership was overwhelmingly positive.  The depth of support, in turn, caused MSNBC to inquire, again finally, why? What was Old Joe Himself missing? MSNBC, in turn, set up a Commission, whose report follows.

Mika Week Commission report to MSNBC.

Review of Morning Talk with Panels, Topics, Guests.  Analysis shows 80% of non-commercial airtime dedicated to exploring
  • Linear Thought Pattern 1: the the mindset of the positioning dominator-type, the linear approach to forcing values and objectives, must get from Point A to Point B and the line is all there is; security is my place on this line and I must get ahead on it or be kicked off, stepped on or over.  The structure itself limits options for progress to goals; this line is all I have;  over the mindset of 
  • Web Thought Pattern 2: the problem-solver, the web-approach to fostering values and objectives. The structure itself offers alternate routes to goals. If this doesn't work, we have this other strand, or this other one.
Findings:

1. Where the difference in mindset was highlighted on the program by Mika the Wise, the Hierarchical Linears could not, could not, absolutely could not,see an alternative to their Linear approach. For them, it was return immediately to fight, knock people off the line, knock the guy off who is at the top of the pyramid, how did we lose, how do we get that place on the line back, and how to reposition to move ahead for oneself.

2.  The Webs, however, confronted with Linears, easily saw and had access to other options to achieve their goals, including becoming Linear temporarily. Point A on a web offers many choices to getting to Point B on the web. Duck, dodge, go around, nobody needs to be knocked off.  Security is the center of a web so that even strands destroyed do not shake the center.

3.  Accordingly, the common good requires that MSNBC give airtime to exploring the merits of a web-based approach to problem-solving, now that the linears have completely tangled their misbegotten, single lifeline, and will drag us all down.

Coffee break:

Why cannot Scarborough be fair? **
Lines, and rules, 
And labels are there.
Life for such is a place on the line.
Without that one line, 
Do I exist? I am where?
Pass the bloke a web.

Further discussion:

  • The Commission also notes that the issue of aggression toward women appears to be correlated to circumstances where the women are far outnumbered by the men, by cultural restriction or other rules or practice.  See Rape Incites Women to Fight Culture, NYT http://www.nytimes.com/2012/12/31/world/asia/rape-incites-women-to-fight-culture-in-india.html?pagewanted=all&_r=0d.  No wonder Mika's comments get sidetracked so often.  It appears that masculinized sex ratios lead to an enhanced pack mentality, leading men to act more violently toward women when in that pack, than individuals may otherwise behave. Morniing Talk:  benefit by demasculinizing the sex ratios in discussions of news, current events, social topics. Ignoring, devaluing any group, including women is violence. Just ask us.
  • A Grand Bargain, combining various topics for resolution at once, is impossible where there is a strong linear presence in thought pattern. A Grand Bargain is only possible where there are web-thinkers on both sides, such being capable of fancy footwork and perspective, whereas linear thinkers can only hang on to their place on the line. Accordingly, a president who can assess the linears and their limitations as accurately as this president can, is to be applauded for acting in increments, step by step, to achieve what web-thinkers, if substantially represented on both sides, could well have done on their own.
  • Democracy requires web thinking on both sides;  linear thinking untempered by web appreciation, leads to autocracy.
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*    Stephen Griffiths, Reuben and Rachel, https://www.youtube.com/watch?v=JCggWO9gDTI
**  Simon and Garfunkel, Scarborough Fair, 1966, https://www.youtube.com/watch?v=ty_TFmL05s0