Navigating the Rehab Landscape

An elderly patient getting out of bed with a walker

After a hospitalization, elderly patients are often referred to “rehab.” What I didn’t realize after my Dad’s heart surgery and stroke was that not all rehab is the same. There are two broad categories of rehab that a patient may go to after a hospitalization:

  • Acute Rehab – This type of rehab often occurs in a specialized facility that is designed for intensive physical, occupational, and speech therapy. Patients are expected to participate in at least three hours of therapy per day, five days a week. Acute rehab is often recommended after a stroke, spinal cord injury, or other serious medical event. While at acute rehab, patients are seen at least three times a week by a physician.

  • Sub-Acute Rehab – This type of rehab occurs in a skilled nursing facility (i.e., nursing home). Patients work with physical, occupational, or speech therapists one to two hours per day. The therapy is not considered to be intensive. After the initial assessment, a physician is only required to see patients every 30 days.

Which rehab is right for your family’s situation? As with everything eldercare related, “it depends.” With my Dad, I fought hard with the case manager and physician at the hospital to get him admitted to acute rehab. I felt this was the best chance for my Dad to regain his abilities and return home, after his stroke. Convincing the decision-makers to refer him to acute rehab was not an easy process. However, I do believe that my Dad’s initial stay at an acute rehab facility and followed by a sub-acute rehab facility enabled him to recover enough to live at home for three and half years. His rehab experience lasted three and a half months.

In some cases, sub-acute rehab is definitely helpful. After my Mom fell and fractured her spine, she was hospitalized for several days. However, the hospital never “admitted” her as an inpatient. As a result, she was not technically eligible under Medicare rules to go to rehab because she had not been an inpatient for three days or more. I called her primary care doctor and discovered that she was part of a Medicare Accountable Care Organization (ACO). This ACO was able to waive the “three-day stay rule” that is typically required for rehab. A few days in a skilled nursing facility was exactly what my Mom needed to regain her strength and confidence after her fall.

In other instances, hospitalizations and sub-acute rehab stays can become a revolving door for some seniors who are near the end of their lives. A recent New England Journal of Medicine article highlights how discussing the goals of care with patients and their families could improve this situation. The authors also note that expanding the Medicare home health benefit could also help.

If your parent has been hospitalized and rehab is on the horizon, I’d recommend three things:

1.     Understand the difference between sub-acute and acute rehab, decide which option would be best for your family member, and then advocate for them.

2.     Find out if your parent’s primary care physician is part of an ACO, which may smooth the path to rehab.

3.     Discuss with your parent what sort of care they want, given their health and stage of life.

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