[img]2962|right|Ken Ruben||no_popup[/img]A shocking conviction has emerged among the friends of Ken Ruben, one of the community’s best known personalities.
They believe the 72-year-old bachelor actually was struck by a major stroke early on Tuesday afternoon of last week, 2½ days before he was found on Thursday evening.
In addition to partial paralysis, Mr. Ruben’s speech is seriously impaired. Between Thursday and Monday evenings, he was moved to three different facilities, most recently Pacific Haven Healthcare Center, Garden Grove.
From Mr. Ruben’s veritable army of friends, this treatment has prompted a remarkable response from a person who has known him for years and does not want to be identified.
The Analysis
I have no background in medicine, rehab or nursing homes. What I have written is strictly based upon my own experiences over many years of handling medical care for a number of family members in a variety of settings.
I am glad the person handling his affairs is receptive to my focus of doing everything possible to get him out of a nursing home and into an acute care rehabilitation facility (aka Inpatient Rehabilitation Facility or IRF) that specializes in rehab for stroke victims. Only two certified such places for stroke victims exist in the city of Los Angeles – the VA and Cedars-Sinai Medical Center.
It will be an uphill fight against the system in all likelihood to accomplish this. It will involve a real commitment since anonymous MDs who never met him before, never had to meet or deal with a representative/advocate for Ken, already have categorized him as incapable of being able to participate in an IRF setting.
However, this is a judgment call without certainty that needs to be questioned and challenged for Ken’s benefit.
As indicated below, the American Stroke Assn.’s guidelines for the medical decision to send a stroke victim to an IRF or not (the decision was made by the team at Fountain Valley Regional Hospital) is that admission to IRFs “is justified only when the rehabilitation team determines that significant functional improvement can be expected within a reasonable time period and the patient can return to a community setting after IRF discharge rather than being transferred to another inpatient or residential facility (e.g., skilled nursing or long-term acute care facility).”
In my opinion, this guideline is clearly driven as much, if not more, by concerns with costs and allocation of medical resources on a systemic basis than anything else. It is not a decision system designed to provide the best benefits for each patient.
In the context of the entire system, the guideline essentially says that if, in the medical team’s judgment (made early) a person cannot fully benefit from the three hours of therapy that insurance/Medicare will pay for in an IRF, then in order to maximize resources for those who are judged early on to benefit from three hours of therapy per day, those patients – the stronger/younger/healthier/less severely damaged patients — will be given the opportunity to benefit from the more specialized, intensive setting provided in an IRF.
Those who are actually more in need never are given that opportunity. They are consigned to the trash bin. They end up in a nursing home, which provides less costly, inferior therapy of a minimal amount.
Snubbing Those More in Need
The sad irony is that the stronger, less damaged patients get better and more therapy. The weaker and more damaged ones get minimal and lower quality therapy. Amazing! That is, unless someone intervenes. It will be a great struggle in all likelihood to change the course of action that has been undertaken at this point.
Instead of putting the people who are weaker/more damaged in an IRF and seeing how they do, the system requires the long term decision — that will determine what someone’s life will look like until the day they die — to be made right at the beginning: Who gets quality rehabilitation, who does not.
It is a ham-handed attempt to conserve resources and costs. The focus is on not “wasting” resources and $$ on people who are less likely (not a certainty) to benefit from the extra resources in an IRF setting.
In essence, the “weaker”/more damaged patients pay the costs associated with this process.
That is again, unless someone intervenes and is prepared to persevere to change the situation.
Home Will Not Be an Ally
In my opinion, the nursing home is not going to be our “friend” in this situation. They want the business. They have no incentive to wholeheartedly try to justify his move to an IRF.
I expect if the home is told you want to get him into an IRF now, they will say, “let’s set up a program for him and see what he can actually do. If we can make some progress so he can do three hours a day of rehab, we can move him to an IRF at that time.”
My suggestion is not to buy into this.
Why?
First, how does one hour of therapy per day with fewer resources and less sophistication ever get a patient to the point where he can do three hours in a more rigorous setting?
Nursing homes cannot provide three hours because they only get paid for one hour by insurance/Medicare. That is an absolute limit.
Second, one hour generally turns into 40 minutes or so in a nursing home, based on my years of experience with nursing homes.
Third, the rehab in a nursing home is only Monday through Friday in most cases. Sometimes they do Saturdays, but you cannot count on it.
Fourth, the quality of rehab in a nursing home is inferior to that in an IRF.
Fifth, despite what they say, the care in a nursing home for people with severe limitations, like Ken's, is in reality, more custodial than rehabilitative.
