Rehab for head injury/stroke in the Stanford Bay Area

[hlh]

An 80 year old relative had a fall and an intracranial bleed (subdural hematoma) and had it evacuated at Stanford. Now is ready for acute rehab and I would appreciate recommendations. She also had a small prior stroke, and some gradual memory issues.

But she was previously very active, traveling the world, not your typical 80 year old.... and I wanted to recommend an acute rehab for her.

Choices from the case manager are

Stanford VA
Santa Clara Valley
El Camino hospital (in Los Gatos)
Good Samaritan (?Mission oaks)

My gut was go to the Stanford VA hospital, which is close to where they live, but she isn't a vet and I don't know why they thought she might qualify (?can any go there private pay if they are on Medicare?). And I'd recommend Santa Clara Valley next although it is a little far for her family to go. Does anyone know anything about the other two, or would you prioritize differently? They are financially secure and want to go to the "best" place.

The docs told her she might only be there for 4-5 days (?) and then step down to subacute rehab. I was hoping she would improve enough and get to stay in Acute rehab until when she goes home, but maybe Medicare is approving only very short stays in Acute rehab these days. Any thoughts? Many thanks.

[Smashms]

at 80 years old i don't know any acute rehab facility that would take her regardless of how healthy she appeared. she has to withstand 3-4 hours of vigorous therapy a day at the min. her best option is to go to a subacute facility. with a brain injury and prior stroke with gradual memory issues i personally think i would not subject her to an acute rehab just for her to be there for a few days then moved to a subacute rehab. we went thru the same thing with my grandmother. it confused her more to be moved twice and eventually moved a third time to a nursing home. because she didn't progress and we couldn't bring her home.

[hlh]

Appreciate your input. I'm sorry to hear about your grandmother.

This is a a little different. All of the therapists and surgeon are in agreement, She does qualify and can do it. Of course the hospital will take her if she has insurance, has an eligible diagnosis and recommendations from therapists. She's already walking around with a walker (didn't use a walker before her recent bleed - was totally independent), and she needs OT and speech too. She is much healthier than she sounds, and has no deficits from her stroke years ago.

Actually, your post makes me a little sad. It reminds me of when my father was injured at age 65. With his white hair, intubated, fractured skull and brain injury, fractured spine and paralyzed with a SCI etc.... You probably know what they thought. I'm so glad I pushed the doctors and got him into the best acute rehab. He's still plugging away almost 10 years later, doing pretty well all considering.

Because you've gotta try, right?

[HockeyFan]

I was in ICU/rehab at Santa Clara Valley Med back in 2014. The doctors and therapists were great. Please feel free to PM me if you have specific questions. Good luck with your decision.

[SCI-Nurse]

No, as a non-veteran, she cannot get care at the excellent TBI center at the Palo Alto VA. There is a little known provision for "humanitarian" admission for non-veterans to VA rehab centers, but only if there is no "comparable" civilian facility within 100 miles, and that is not the case. Since there is no "Stanford" VA (it is the Palo Alto VA that is next door to Stanford University Hospital), I suspect that the case manager was actually recommending the relatively new general acute rehab center at Stanford University Hospital.

I would personally lean toward Santa Clara Valley if they will take her, but also have the concerns about the very open discrimination against elderly persons with CNS trauma that takes place both in insurance companies and the rehab industry. This comes from Medicare regulations that can fine the rehab facility for Medicare recipients admitted to inpatient rehab programs who end up being discharged to sub-acute or nursing home facilities instead of to home. Of the facilities you list, only Santa Clara Valley and the Palo Alto VA are CARF accredited as Brain Injury Specialty Programs. There are several others in the Bay area, but not these other

If she can tolerate 3 hours of therapy daily (PT, OT, and SP), then try to get her into such a program. A sub-acute program will provide at most only 1 hour of therapy daily, and these facilities are usually ill-equipped for TBI rehab needs, instead having their most experience in orthopedic (joint replacements, etc.) and stroke/CVA rehab.

(KLD)

[hlh]

Many thanks KLD. My slip up on the VA name. I meant Palo Alto VA. It didn't make sense to me that she would be referred there, so I appreciate you clarifying.

And thanks for explaining the Age issue. I wasn't aware of that penalty.

I'll push for her to get to Santa Clara Valley.