What are my Options for Rehabilitation Services?
A person may be referred for rehabilitation services for many reasons. Some seek rehabilitation after an injury, illness or surgical procedure. Others may seek rehabilitation services after experiencing declines in strength, range of motion, balance, mobility and for acute or chronic pain. Your doctor is a great resource for referrals to therapy and community resources, but it can be helpful to know what your options are before choosing your rehabilitation setting. Here is a summary of your rehabilitation options, starting with the most intensive:
1) Sub-Acute Inpatient Rehabilitation:
People are typically transferred to sub-acute rehabilitation facilities after being discharged from the hospital. The general rule-of-thumb is that you must have a qualifying 3-day hospital stay to be accepted into this level of care, however there may be some flexibility with this regulation under specific circumstances. There are some occasions where someone can be admitted to inpatient rehab from home in the event of a significant functional decline, but this generally requires the effort of a care team and is not common. Patients must require at least two therapy disciplines (physical, occupational and/or speech therapy), as well as nursing care.
Sub-acute rehabilitation is one of the most intensive rehabilitation options available. People who are in sub-acute rehabilitation centers receive at least 3 hours of therapy, 5 days per week. The average length of stay is 1-3 weeks, depending on the reason for admission and the client’s functional level. The goal of inpatient rehabilitation is to get the client to a level where they can be safe to return home, with or without the assistance of family or caregivers. Caregiver training is often included as part of the rehabilitation process. A person may or may not return home from inpatient rehabilitation at their baseline level.
2) Skilled Nursing Facilities (SNF):
Skilled nursing facilities also provide rehabilitation services in an inpatient setting; however the intensity is not as high. People can be transferred to a SNF directly from the hospital, or they may transfer to a SNF after spending some time in a sub-acute rehabilitation center. People usually receive 1-2 hours of therapy per day in a SNF, and the amount of therapy is related to the person’s medical history and functional level. People may go to a skilled nursing facility instead of an inpatient rehabilitation, if they are not able to tolerate a full 3 hours of therapy, or if their progression is expected to occur at a slower pace. The average length of stay is highly variable and may go up to 4-6 weeks. People in a skilled nursing facility, must also demonstrate a need for skilled nursing services, which may include wound care, IV infusions, medical management, etc.
3) Home Health Therapy:
People who are being discharged home from the hospital or an inpatient rehabilitation center, are often referred for home health services. Home health services are exactly as they sound – service providers will come to your home to provide care. To qualify for home health services, a person must be considered home-bound, which means that they are physically or medically unable to leave the home, unless visiting the doctor, a religious service or other necessary community service. Services available under home health include nursing, physical therapy, occupational therapy, speech therapy, social work, and home health aids. Home health clinicians can address wound care, medical management, catheter management, IV’s, as well as physical rehabilitation. Providers bring any equipment that they need into your home (weights, TheraBand, medical supplies), and take it back with them when they leave. They may also use items within your home to assist with treatment. The goal of home health therapy is to make sure that clients are safe in their home for self care and ambulation, and if-able, get them to the point where they are strong and safe enough to resume getting out into the community. The frequency and duration of services is highly variable and is based on medical necessity. Home health services are generally 100% covered under Medicare, part A.
4) Outpatient Rehabilitation:
Outpatient rehabilitation services are provided in a stand-alone clinic within the community. Clients must be able to get transportation to/from rehabilitation and get in and out of the clinic, with or without the assistance of a caregiver. Providers that offer outpatient services are physical therapists, occupational therapists, and speech therapists. Clients who require nursing interventions at an outpatient level will receive these services at a doctor’s office or wound clinic. Many outpatient centers include exercise equipment, therapy mats and a variety of modalities including heat/ice, ultrasound and e-stim (electrical stimulation). The guidelines and goals for outpatient services are not limited to a patient’s ability function in the home, and can address a larger variety of concerns with higher level goal-setting at a community level. Outpatient services are covered under Medicare, Part B. Depending on your insurance plan, you may have a copayment or coinsurance (typically 20%) for outpatient services.
5) Mobile-Outpatient Services:
This is a new category that is emerging. Mobile outpatient providers are essentially outpatient therapists that make house-calls. This option is ideal for clients who may have been discharged from home health services and are still unable to leave the home to access outpatient care, or for those who may not qualify as being “home-bound,” but would still prefer to be seen at home. Mobile-outpatient providers are able to maintain the flexibility of goal-setting and intervention of being in an outpatient setting, with the added benefit of being able to receive services in your home. Mobile-outpatient services are covered in the same way as outpatient services, under Medicare part B, and may also be available through other providers in or out of network, or private-pay.
How do I Access Rehabilitation Services?
For most rehabilitation services, a referral may be required from your doctor to initiate care. For outpatient occupational and physical therapy services, some insurance plans allow direct access (you can go without a referral), but your primary care physician must be willing to sign off on the clinician’s treatment plan for insurance regulations. Your medical team will be a primary deciding factor if you are needing inpatient level care, but you will have the opportunity to request which facility you would like to receive services at. There may be some restrictions to your choices based on the following:
Insurance coverage
Census (if the desired facility is at full capacity)
Diagnosis and Medical Necessity: Some inpatient facilities are required to maintain a specific ratio of patients with specific diagnoses. There may also be requirements for a specific level of medical complexity or need.
If you are seeking outpatient level care, you can also obtain guidance from your medical team. If home health therapy, outpatient, or mobile outpatient therapy is recommended or requested by you, you will also have a choice in which provider you choose. Some restrictions for outpatient level care may be:
Insurance coverage
Scheduling: Are there enough providers available, and does their availability match with yours?
Diagnosis: Does the provider you wish to see have expertise with your specific condition/concern?
What questions do I ask when Calling a Rehabilitation Provider?
For Inpatient Settings. Your case manager should be able to assist with answering some of these questions, but you are able to call on your own and get information:
What is your Medicare star rating? See the link below to the Medicare website where you can compare ratings on facilities to get more information on the quality of care provided. This is a 5-star rating system that rates care, quality, and outcomes.
Are you accredited with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)? This is an optional accreditation for healthcare facilities that hold high standards for compliance, medication management, outcomes, infection control, and performance.
What is this visitation policy/visitation hours?
Will family training be provided before discharge?
What things do I need to send along with my loved-one?
How many hours of therapy are provided?
For Home Health or Outpatient Services:
What insurances do you accept? Will I have a co-pay/coinsurance?
Will there be consistency with the care providers, each session?
Will I have a consistent schedule each week?
Does the clinician I will be seeing have experience with my condition/concern?
Does the clinician have any specialty certifications or advanced training?
How long is an average session?
Are caregivers and/or loved ones able to be present during sessions?
Knowing your options can help give you confidence when making choices regarding your care. There rehabilitation service options available for people of all needs, abilities, and conditions. Your primary care physician can be a great resource for determining the best option, but we also want to empower you with the ability to look at options available within your community and make the best possible choices for your unique needs. For more information on specific therapy types, please see our post on “What is the Difference Between Physical Therapy and Occupational Therapy?”. If you find yourself in a position where you are providing care for a loved one after discharge from the hospital and need some training or guidance, also feel free to check out our book A Therapist’s Guide to Caregiving for detailed step-by-step instructions, or our comprehensive caregiver training video course for online education.
Resources:
A Therapist’s Guide to Caregiving
The book includes 170 pages of full-color, step-by step instructions, to provide you with all the skills you need to provide safe, thorough, and compassionate care at home.
This is your comprehensive guide to giving you with the skills you need to provide safe, effective, and compassionate care to family members, friends or clients in the home. This course includes 6 hours of instructional video covering client basic adaptive equipment, functional mobility, lifting techniques, transfers, self-care skills, bed level care, use of client lifts and transfer devices, and managing falls. Click "Preview Caregiver Course" below to preview the lessons and descriptions.
