Rehabilitation after Surgery, Stroke or Hospital Stay

What happens if you still need help after a hospital stay?

It is common to need help to regain strength, manage a chronic illness, or re-learn activities of daily living after a hospital stay. But who determines what type of rehabilitation is needed? Who determines if help at home or in a facility is best? What are the criteria for release to a rehabilitation facility as set out by Medicare, Medicaid and private insurance? (Jump to Lessons Learned)

Rehabilitation covers a variety of illness or diseases including arthritis, cancer, cardiac disease or neurological problems. It is designed to help a patient become medically stable. Medically stable does not mean that your loved one will return to the same level of activity they had prior to the hospital stay.

An assessment of functional impairments and what help is needed with activities of daily living (ADLs) determine if you can safely manage at home or if you require care at a skilled nursing facility (SNF) or extended care facility (ECF). Safety, the need for supervision, and of course insurance, all impact this decision. Source: Rehabilitation.

There are three types of rehabilitation facilities for post hospital care:
1. Acute Rehabilitation Facility or Long Term Acute Care Hospital (LTACH)
These facilities take care of patients that need:

More “contact time” with therapists for more aggressive therapy such as for strokes, double knee, bilateral hip replacement or TBI

Require therapy for a longer period such as long term IV therapy

Patients are released to this type of facility when they:

No longer need the 24-hour follow-up of acute hospital care, but continue to need large amounts of rehabilitative care

For billing/insurance benefit purposes:

Acute Rehabilitation facilities and Long Term Acute Care hospitals are the same

2. Post-Acute Care – (also called Sub-Acute Rehabilitation (SAR), Subacute Rehab, Short Term, or Skilled Nursing)
These types of facilities take care of patients that have:

A level of stability above what an acute rehab facility or LTACH requires, such as:

• A congestive heart failure (CHF) patient, where CHF is not acute, but the person overly compensates for it
• The required contact time with rehabilitation therapists is less. (e.g. a single knee replacement vs. a double knee replacement)
• When it is deemed it is not safe for the patient to go home using out-patient rehabilitation

The levels of care received at this type of facility is dictated by Medicare.

The maximum amount of rehabilitative care you can receive at this type of facility are therapies up to five days a week, no more than three hours a day.

The three hours is a mix of Physical Therapy, Occupational Therapy and group mixed therapy.

3. Long Term Care – also known as a Skilled Nursing Facility (SNF) or Custodial Care

Patient requires full contact time from a licensed professional but there is no safe discharge to a patient’s home

When a patient doesn’t need the acute care of a hospital but does require 24-hour home care due to a fall risk, or dementia

There is no one at home to fulfill the 24-hour care. (e.g. wound care or IV therapy WITHOUT need for Physical/Occupational Therapy)

Lessons Learned:

If you schedule knee or hip replacement, research and tour rehabilitation facilities prior to surgery. This proactive approach ensures you know ahead of time if your insurance will pay for the facility you want.

If you have a date for your surgery and have decided on a facility, many rehabilitation centers will reserve you a room. Some encourage you to drop off what you will need to stay there ahead of time to make the transition day easier.

Keep in close contact with the facility during and after your stay. When a summary of care is sent to your regular doctor, close contact increases the likelihood of effective follow-up care. Plan telephone calls from knowledgeable professionals within two days after discharge. This helps patients and caregivers anticipate problems and improve care at home.

There are barriers to admittance to these facilities, so you need a backup plan. Barriers include:

• The patient has not named a Durable Power of Attorney or Healthcare proxy and no active decision maker has been named by the patient.
• There is not a safe environment or responsible party at home to whom they may release the person upon discharge
• Insurance coverage: Your Medicare days are maxed out OR the cost of your care needs exceeds insurance coverage

Note: When dad was released from the hospital, he was not discharged to a rehabilitation facility, he received nursing and rehabilitation from a Medicare certified home health agency. You can read about our experience here: Medicare paid home health care

With thanks to my collaborator on the Rehabilitation series, Emily Lintag

Emily Lintag is a hospital and health care professional who has served as a sub-acute rehabilitaion nurse, assisted living charge nurse and wellness nurse. In addition to serving as coordinator and hospital liaison with several rehabilitation facilities.

Disclaimer: The material in this blog is for educational purposes only. It is not intended to replace, nor does it replace, consulting with a physician, lawyer, accountant, financial planner or other qualified professional.

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