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March 2003

By Sarah Schmelling

SAVING RANCHO

Chances are that you know something about Rancho Los Amigos National Rehabilitation Center in Downey, Calif. If you have never visited the center directly, you have a colleague who did an internship there or a client who has been treated there. You have studied the Rancho Cognitive Scale, or read any number of studies that have been conducted at the facility.

You also probably know that Rancho, as we know it, may soon no longer exist.

As has been reported in numerous publications and national news broadcasts, in January the Los Angeles County Board of Supervisors announced that Rancho, though it has lasted since the 1880s, has roughly 68,000 outpatient visits per year, and in recent years has always ranked in the top 10 of US News and World Report’s list of rehab facilities, would have to close its doors in June. Despite an outcry from angry protestors, including many patients, the board, facing a projected $750 million health budget deficit over the next 3 years, said they had no choice.

Of course, as the only rehab facility of its kind in Los Angeles County, Rancho is not short on supporters who have started the drive to save it. Leading the charge is the California Community Foundation, which is working to raise funds and develop a plan through which Rancho could be converted into a nonprofit hospital. Jack Shakely, president of the foundation, is due to report his findings to the Board of Supervisors on April 1. Other actions that may delay or prevent the closing are two lawsuits. The first, a class-action suit, was filed by a coalition of disability rights activists, including about 5,000 Rancho patients, who say the closing would violate the Americans With Disabilities Act because, without Rancho, many of its patients would have nowhere else to go for treatment. The second suit was filed by Neighborhood Legal Services, the Legal Aid Foundation, and the American Civil Liberties Union, also claiming the closure violates the law and endangers the lives of patients.

Specific services unique to Rancho, says Greg Thompson, director of social work at the facility, include its pressure ulcer management service, dental clinic, urology clinic, and post-polio clinic, where patients come from Northern California because they cannot find treatment elsewhere, he says. If Rancho should close, patients for these and other rehab services will have nowhere to turn but hospital emergency departments, Thompson says, which will fill up beds needed for other patients with possibly more acute conditions.

But as unsettling as this may be, short of raising funds, what can most people in the rehab community do about it? On the practical side, Thompson says, PTs and OTs can suggest hospital referrals to Rancho administrators, so patients will have somewhere to go should the facility shut down.

The important lesson here, though, he says, is “if this can happen in a place like Los Angeles, it can happen anywhere.” So first, we can learn from the efforts to save Rancho—looking at new ways of financing, and fighting back on behalf of those with disabilities. We can also see how vital it is to get the word out about the importance of rehab. “Letters [to the Board] are always helpful, but also pay attention to what politicians are saying,” Thompson says. “More important, empower patients to speak for themselves.”

In short, watch what happens with places like Rancho as budgets get tighter around the country, so that you too do not have to fight to keep facility doors open, and if you do, you just might know what steps to take. Meanwhile, keep doing the good work of rehabilitation and spreading the word about its importance. As Thompson says, “people need to know that rehabilitation works, but only if you invest the time.”

—Sarah Schmelling
cwolski@medpubs.com

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