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 recover and get back to as close to “normal” as possible.
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:
Patients are released to this type of facility when they:
For billing/insurance benefit purposes:
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 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.
3. Long Term Care – also known as a Skilled Nursing Facility (SNF) or Custodial Care
- 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.