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FamilyCaregiverGuidePlanning for InpatientRehabilitation (Rehab)ServicesWhat Is Rehab?If your family member is in the hospital for an acute illness orinjury or for surgery, you may be told that the next step in care is“rehab.” Rehabilitation (or simply “rehab”) is treatment to helppatients regain (get back) all or some of the movement andfunction they lost because of the current health problem.Many patients say that thetransition (move) from ahospital or other caresetting to rehab can bevery confusing.Rehab itself is very different from hospital care. While your familymember might still be quite ill and need medical attention, he orshe will be expected to be active during the rehab process. Rehabis hard work.You will find that things are done differently in rehab than in ahospital. You will see many active patients and therapists in thehalls and treatment rooms. In general, you will find that rehab hasan active, “workout” atmosphere that may not feel like a place forsick people.Your family member will be expected to work as hard aspossible during the rehab process, and you will have manyresponsibilities. For example, you will be expected to provideloose, comfortable clothing for your family member to make iteasy for him or her to get dressed and to take part in therapysessions. You will be expected to participate in meetings with themedical team. This will allow you to ask questions and understandyour family member’s rehab process.www.nextstepincare.org 2008 United Hospital Fund1

Inpatient Rehab ServicesHere are five important points to remember:1. The goal of rehab is to help patients be independent —doing as much for themselves as they can.2. Rehab is done with a patient, not to a patient. Your familymember must be willing and able to work with rehabservices during active treatment and, later, with caregiversor by themselves at home.3. The patient’s chronic (long-term) health conditions, suchas high blood pressure or cholesterol, are treated duringrehab, but they are not the reason the patient is in rehab.4. Most rehab services last weeks, not months.5. Most insurance policies cover rehab when ordered by adoctor, but there will probably be extra costs.Where Are Rehab Services Provided?Patients can get rehab services at home, in a local clinic, or at aninpatient setting (either a rehab unit within a hospital, nursinghome, or a separate rehab facility).While this guide looks only at inpatient rehab services, rehabservices can be provided by a home health agency as a “skilledservice.” In this case, your family member must be well enough tobe at home. You may want to consider whether home careincluding rehab is an option for your relative. There are alsooutpatient rehab services. In this case, your family member mustbe able to travel back and forth to the clinic or hospital thatprovides rehab.www.nextstepincare.org 2008 United Hospital Fund2

Inpatient Rehab ServicesInpatient Rehab SettingsInpatient rehab can take place at any of these settings:Rehab unit within a hospital or a separate inpatient rehabfacility (IRF). These rehab programs are usually very intense.Patients must be able to benefit from, and receive, at leastthree hours of therapy five days each week. Some patients maybe admitted even though they are not able to tolerate anintense program at first if the therapists believe that thepatient will be able to improve quickly. If possible, talk withyour family member about whether this setting is right for hisor her needs. Think about his or her current illness as well asother chronic health problems. Check with your familymember’s doctor and physical therapist about this level ofrehab.Rehab unit within a skilled nursing Facility (SNF)—alsocalled a nursing home. Most patients who are discharged torehab go to a SNF (pronounced like “sniff”). These programsoffer the same types of services as an IRF but at a less intenselevel. Rehab services at a SNF are not the same as long-termcare in a nursing home. Indeed, most patients at a SNF aredischarged home when rehab is over. Some patients do moveto the regular long-term care part of a SNF, however, so youshould be aware of this possibility.Special settings. Some types of rehab take place in specialsettings such as brain injury units or cardiac (heart) units. Askhospital staff if this is an option you and your family membershould consider.www.nextstepincare.org 2008 United Hospital Fund3

Inpatient Rehab ServicesMaking a Choice about SettingsA discharge planner inthe hospital (usually anurse or social worker)will provide a list of rehabsettings appropriate foryour family member. Youand your family memberwill be asked to chooseup to five places whereyou are willing to go.When there is an openbed at any of thesesettings and your familymember is well enough toleave the hospital, youwill be asked to acceptthis placement and leavethe hospital. You will nothave much time—anotherreason you shouldbe prepared.The hospital treatment team may suggest that your familymember go to rehab after leaving the hospital. (Sometimes staffmembers will say “go to a nursing home” when what they reallymean is going to a rehab unit in a SNF.)Rehab settings are different from hospitals. They decide whichpatients they accept on the basis of whether the person canbenefit from the level and kind of services they provide. So, evenif you decide, for example, that your family member would like tohave rehab in an IRF, the IRF may not be willing to accept him orher.Here are some things to think about when making a choiceabout rehab setting:Amount of services. Some rehab settings are more intenseand active than others. Think about your family member’scurrent health problem as well as any chronic concerns. Talkabout these with your family member’s medical team to makethe best choice.Location. The ideal is to find a rehab setting near where youlive or work. This way, it is easy for you to visit. You might wantto go to therapy with your family member, learn how to helpyour family member do the exercises, find out how to get thehouse ready, help plan for discharge, or offer comfort andmoral support throughout the rehab process.Cost. Medicare, Medicaid, and most private health insuranceplans may pay all or some of the rehab costs. But there arestrict guidelines, and you need to pay all costs that insurancedoes not cover. It is important to learn as much as you can. Youcan do so by talking with the discharge planner or someone atthe financial office in the rehab facility.www.nextstepincare.org 2008 United Hospital Fund4

Inpatient Rehab ServicesRehab ServicesPatients often work with two or more rehab services. Theseinclude:Physical therapy (PT). This helps patients with problemsmoving, balancing, walking, and performing other activities.PT can also help patients with prosthetic (artificial) arms orlegs, shoe inserts, wheelchairs, walkers, and other assistivedevices.Occupational therapy (OT). This helps patients be moreindependent with self-care and other daily tasks, such aseating, getting dressed, typing, and using the telephone.Speech therapy. This helps patients relearn language skillssuch as talking, reading, and writing. It can also help withswallowing problems.Psychological counseling (or simply “counseling”). Thishelps patients (and sometimes also their family members)adjust to major life changes caused by an illness or injury.Counseling may be offered individually (one patient at a time)or in a group.Going from Hospital to Inpatient Rehabto HomeGoing from hospital to rehab. Hospital staff should tell therehab staff about what they did as treatment and care for yourfamily member.Clothing. Your family member will need to wear loose,comfortable clothes (not gowns) to participate in therapysessions (such as physical therapy or occupational therapy).The facility does not provide such clothing, so you will have tobring them from home or buy them. It is important to putlabels in the clothing and bring them to the rehab facility atthe time of admission. Make sure to ask the rehab team aboutthe facility’s specific policies about clothing.www.nextstepincare.org 2008 United Hospital Fund5

Inpatient Rehab ServicesInitial assessment for restorative potential. Rehab staff willassess your family member within two days of admission. Themost important finding is “restorative potential.” This meansthe level of function (ability to move or do activities) that yourfamily member is likely to regain from rehab. Restorativepotential has to do with only the current illness, and not anychronic condition, such as diabetes, arthritis, or dementia.Insurance pays for rehab only when your family member ismaking progress toward restorative potential.Going back to thehospital. During therehab stay, your familymember’s medicalcondition may change. Heor she may need to behospitalized. In thatevent, he or she may beable to return to the rehabsetting or a long-termplacement may be moreappropriate. Ask thesocial worker, or someoneat the financial officeabout the facility’s “bedhold” policy—the amountof time it will hold yourfamily member’s bedduring a hospital stay,and the financialresponsibility for holdingthe bed.www.nextstepincare.orgRehab begins. The amount of time your family memberspends in rehab depends on the type of setting. Staff willassess your family member throughout the rehab process tomake sure he or she is making progress toward restorativepotential.Care plan (“team”) meeting. This meeting takes place afterrehab has started. It includes staff from nursing, social services,dietary, recreation, and rehabilitation who discuss your familymember’s progress. You and your family member will be askedto attend. This is a good time to ask questions and raise anyconcerns.Discharge to home. Patients are discharged from rehab whenthe team assesses that they have reached a “plateau” (a timewhen the patient is not making any progress, but is notgetting any worse). This means that the patient is not likely tomake more progress. When your family member reaches aplateau, rehab staff will give you a written notice stating thatMedicare or other insurance will end on a certain date (oftenthe day after this notice is given). Speak up and let the staffknow if you feel that your family member needs more time.Rehab after discharge. Many patients continue their rehabafter leaving an inpatient setting. This can happen at home orin the community as an outpatient. Many patients feel muchbetter and improve quickly when they have returned to thecomforts of home. 2008 United Hospital Fund6