Rehabilitation Options¶
Evan Berlin, Scott Miller, Adam Epps, Lauren Massey
Physical medicine and rehabilitation (PM&R) physicians focus on restoring function and quality of life to those with physical impairments or disabilities affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons
Physiatrists specialize in determining appropriate rehab options for hospitalized patients
Acute Inpatient Rehabilitation (IPR) or Inpatient Rehabilitation¶
facility (IRF):
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IPR involves a multidisciplinary team of physicians, physical therapists, occupational therapists, speech and language pathologists
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Pts admitted to IPR must be able to tolerate a minimum of 3 hours of rehab per day for 5 days a week
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Pts must have medical complexity warranting medical supervision by a physician
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Physicians are required to evaluate admitted patients at least 3 times a week
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Average length of stay (LOS) in acute inpatient rehab is 10-12 days
Skilled Nursing Facility (SNF):¶
- Patients admitted to SNF require skilled needs: Wound care, IV
therapy, Catheter care, PT, OT, and/or SLP
- There are no minimal requirements for daily therapy, but patients
may receive up to 1.5 hours/day, depending on availability at the
facility (in practice it is often less than this)
- Physicians are required to evaluate admitted patients at least once
every 30 days
- Average length of stay is 26 days
Long-Term Acute Care Hospital (LTACH):¶
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Pts admitted to LTACH require extended hospitalization and include pts who will be receiving prolonged mechanical ventilation
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Pts will be recommended for transfer to an LTACH when no reasonable functional or medical improvement can be expected in an acute inpatient stay
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LTACHs can be within a hospital or may be free-standing
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Average length of stay must be greater than 25 days
Assisted Living:¶
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Pts receive a combination of long-term housing, personal care services, and health care
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Designed for individuals who need assistance with activities of daily living
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Can be provided in freestanding communities, near or integrated with SNFs, hospitals or retirement communities
Outpatient Services:¶
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Can be ordered at discharge with or without official PT/OT recommendations
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Home health (HH): wide range of healthcare services provided in patients home ranging from wound care to IV antibiotics
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HH PT/OT: pts can receive therapy at home when unable to attend outpatient PT/OT
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HH nursing services: required for IV antibiotics or PICC line maintenance; consider for wound care, other services include medication adherence and reconciliation
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HH non-skilled aide: outside the scope of acute hospitalization, but helps with ADLs
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Outpatient PT/OT: Consider for those who would benefit from therapy but do not meet the qualifications for other dispositions or would prefer outpatient therapy