Rehabilitation Options

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):
    • IPR involves a multidisciplinary team of physicians, physical therapists, occupational therapists, speech and language pathologists
    • Pts admitted to IPR must be able to tolerate a minimum of 3 hrs of rehab per day for 5 days a week
    • Pts must have medical complexity warranting medical supervision by a physician
    • Physicians are required to evaluate admitted patients at least 3 times a week
    • Average length of stay (LOS) in acute inpatient rehab is 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 hrs/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):
    • Pts admitted to LTACH require extended hospitalization and include pts who will be receiving prolonged mechanical ventilation
    • Pts will be recommended for transfer to an LTACH when no reasonable functional or medical improvement can be expected in an acute inpatient stay
    • LTACHs can be within a hospital or may be free-standing
    • Average length of stay must be greater than 25 days

 

  • Assisted Living:
    • Pts receive a combination of long-term housing, personal care services, and health care
    • Designed for individuals who need assistance with activities of daily living
    • Can be provided in freestanding communities, near or integrated with SNFs,  hospitals or retirement communities

 

  • Outpatient Services:
    • Can be ordered at discharge with or without official PT/OT recommendations
    • Home health (HH): wide range of healthcare services provided in patients home ranging from wound care to IV antibiotics
    • HH PT/OT: pts can receive therapy at home when unable to attend outpatient PT/OT
    • HH nursing services: required for IV antibiotics or PICC line maintenance; consider for wound care, other services include medication adherence and reconciliation
    • HH non-skilled aide: outside the scope of acute hospitalization, but helps with ADLs 
    • 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
      • Pt would attend therapy sessions at an outpatient clinic
      • If a pt is receiving other HH services, they do not qualify for outpatient PT/OT