Choosing the Right Rehab
By Susan Rogers, MSG. Prestonwood Rehab, Collin LIVING WELL Magazine
There have never been more options available for someone needing to regain their health and strength. Today, patients can choose from rehabilitation hospitals, skilled nursing facilities, outpatient clinics and home health care. Often patients and their families feel overwhelmed by these options and are unsure which to choose. While these options share much in common, there are some very important differences that will help determine the right rehab setting.
Outpatient clinics primarily meet the needs of persons who have an injury that does not prevent them from carrying out their normal routine. An example of someone who could benefit from an outpatient clinic would be someone who is in good health, but has a broken arm. This person could receive physical and occupational therapy several times a week at an outpatient clinic, and could still work or maintain their normal lifestyle with a few modifications.
An example of someone who would benefit from home health care would be someone who is homebound because of balance problems. The home health agency would send a physical therapist three times per week to help the patient improve their balance.
Rehabilitation hospitals and skilled nursing facilities both offer inpatient nursing care and physical, occupational and speech therapy under the direction of a physician for someone whose injuries or condition prevents them from maintaining their normal routine. This care is covered by Medicare or other insurance policies in certain situations.
Recently, a number of rehabilitation hospitals have opened in the area. This is a trend that should continue as the Baby Boomers enter their 60s and beyond and require rehabilitation after an accident or injury. Patients at a rehabilitation hospital must have the ability to complete a minimum of three hours of therapy per day, five days a week. This intensive schedule is best suited for persons who were in a relatively good state of health prior to hospitalization, and who don’t have many medical complications. The length of stay at a rehabilitation hospital is generally determined by the patient’s diagnosis, but averages between 14 to 21 days. In addition to Medicare, rehabilitation hospitals accept most major insurance plans, so are able to provide care to adult patients of all ages. A patient may be admitted to a rehabilitation hospital from the emergency room, hospital or even from home, with an order from their doctor.
A skilled nursing facility is a great option for someone who can’t tolerate the intensive therapy at a rehabilitation hospital, for someone who has completed a stay in a rehabilitation hospital, but is not quite ready to go home, or for someone who may need more than three weeks to recover. Medicare is the most common insurance policy used to cover the cost of a stay in a skilled nursing facility, and therefore most patients in this setting are 65 or older. Medicare covers the stay if the patient has had a minimum of a three-night hospitalization. Medicare pays for the first 20 days at 100% and then up to an additional 80 days with daily co-pay often covered by a supplemental policy. There is no limit to the number of 100-day stays a person can have in their lifetime; however, between each stay there must be a 60-day “break in the spell of illness.” Medicare covers five physical, occupational & speech therapy sessions per week as ordered by the doctor. The amount of physical, occupational and speech therapy provided during those sessions is determined by the patient’s condition.
Often patients will use a combination of these types of rehab during their recovery. A person unable to bear weight on their leg after a fracture may start out in a skilled nursing facility and then move to a rehabilitation hospital when they have built up enough strength. When they go home, they may continue with outpatient therapy or home health care. Every facility employs a social worker or case manager to help patients and their families choose the right rehabilitation setting, so fortunately, you don’t have to make these decisions alone.
