- What is Rehabilitation?
- Rehabilitation Settings
- Advantages and Disadvantages
- Rehabilitation for Certain Conditions
- Common Medical Problems During Rehabilitation
What is Rehabilitation?
If you have ever suffered from an injury or sudden illness you know the importance of rehabilitation. It is what gives you back your independence and restores your quality of life.
Rehabilitation is among the most complex and specialized fields in all of medicine. It encourages individuals to do things for themselves so they can return to their pre-level of functioning as soon as possible.
There are a number of places you can go for your rehabilitation depending on your needs.
Skilled nursing homes and nursing care facilities offer short- and long-term care that focuses on helping individuals function after an illness or injury. While the services provided may vary among skilled nursing facilities (SNF), the following are typically provided.
- Prescribed medical treatment
- Physical, occupational and speech therapy
- Help with daily activities, including; eating, walking and bathing
- Social services
- Case management
Medicare Part A will pay for post-hospital care in an SNF if you meet certain requirements.
- Your stay must be a minimum of three days that doesn't include your discharge date.
- You have to enter the facility within 30 days of your hospital stay.
- The skilled nursing facility must be ordered by your physician.
- Your level of care must be supervised by a registered or licensed practical nurse, physical therapist or intravenous injections.
- You are not able to receive your required level of skilled care at home or as an outpatient.
Under Medicare you won't be charged for the first 20 days of your stay. If you are there between 21 and 100 days you might have to pay $137.50 per day and for stays longer than 100 days you are responsible for 100 percent of your costs.
Home care rehabilitation is often recommended for those who have been discharged from an inpatient rehab program. Medicare-provided home health care services include help with everyday activities such as cooking, cleaning and bathing, or medical care that calls for a licensed and skilled health care provider. The costs of these services are only covered if your physician prescribes them.
To receive coverage you must choose a Medicare-approved home health agency and meet the qualifications of your Medicare, Medicare Advantage or MediGap/Medicare Supplemental plan.
In addition to Medicare, there are other state and federal sources for coverage. For example, those with low incomes may be covered under their local Medicaid program. For those with limited income, there also may be local community programs to assist seniors or individuals with certain disabilities with their daily living needs. The provider you choose will help you apply for the coverage for which you qualify.
Outpatient rehabilitation facilities provide you with the doctors, physical therapy and social or psychological services to help you recover from an injury, illness or disability. To participate in an outpatient program your physician needs to design a treatment plan for you that must be reviewed every two months. Medicare will pay 80 percent of the cost of your care with you or your supplemental insurance paying the remainder. You will incur special charges if you receive medical equipment or supplies.
Hospital-based rehabilitation offers a multidisciplinary team approach. The team members will vary depending on your situation.
Members and Activities of the Rehabilitation Team
|Medicine||Manages acute and chronic illnesses|
|Nursing||Helps in coping and adapting to illnesses and coordinates medical and nursing care plans with rehabilitation|
|Occupational Therapy||Evaluates and improves arm function; improves performance of everyday activities; helps adapt to visual and perceptual deficits and in evaluating and treating swallowing disorders|
|Physiatry||Develops plan for continued physical, occupational and speech therapy|
|Physical Therapy||Evaluates and improves leg function, range of motion, strength, balance and endurance; teaches how to use assistive devices; and provides gait training|
|Psychiatry||Conducts psychiatric evaluation and treatment and provides family support|
|Psychology||Offers psychological support and assistance to rehabilitation teams|
|Social Work||Assists in discharge planning; helps families cope with illness and disability; and provides financial and personal counseling|
|Speech Therapy||Evaluates and treats communication, speech and swallowing disorders|
Generally, hospital-based rehabilitation is short-term. If you had a stroke you can expect to spend six to eight weeks in the hospital and about two weeks for a hip fracture. To qualify for Medicare reimbursement you need to meet the following criteria:
- Close medical supervision and care by a rehabilitation doctor
- 24-hour rehabilitation nursing care
- Participate in at least one discipline (i.e., physical, occupational and speech therapy)
- A team approach to your therapy and a coordinated rehabilitation program
- Clear and realistic goals for your rehabilitation
Advantages and Disadvantages
There are advantages and disadvantages for each rehabilitation setting. Hospital-based care is the most difficult. It requires three hours of active therapy each day, making it prohibitive for frail seniors. Skilled nursing facilities and their 24-hour care are recommended if you cannot care for yourself or don't have a full-time caregiver. Many seniors prefer to take advantage of outpatient services in the comfort of their own homes but the care they need isn't always available. Going to an outpatient facility also requires transportation that can be expensive.
Rehabilitation for Certain Conditions
As you age, certain conditions may warrant rehabilitation. If you have suffered a stroke, chances are your rehabilitation will be done in a hospital, an acute care hospital or a skilled nursing facility. Individuals who receive coordinated, multidisciplinary care benefit the most. Your physical therapist will focus on improving your ability to walk safely, most likely with an assistive device such as a walker or cane. Your occupational therapist will concentrate on any weaknesses and coordination of your arms, thinking and perception. They also will evaluate your ability to swallow. Your speech therapist will formulate a program to restore your ability to speak or devise another way for you to communicate.
Hip fracture rehabilitation focuses on improving your functionality and strengthening your leg muscles. Typically you will be hospitalized anywhere from three days to one week. Your physical therapist will encourage you to move from your bed to a chair several times the day after surgery. Next you will be walking with crutches or a walker. You'll be discharged once you can get around safely, perform your exercises and your caregiver has made all the needed preparations for you to go home. Once discharged, your therapist may schedule one to six in-home treatments to assure you are safe in and about your house and getting in and out of your vehicle. They'll make recommendations about your safety, review your exercise program and continue working with you on your goals. Following home therapy, your surgeon may prescribe four to eight weeks of outpatient therapy to help you regain range of motion, maximize your strength, walk without a limp and resume your activities.
Common Medical Problems During Rehabilitation
During your rehabilitation all efforts will be made to prevent additional illnesses or disabilities. These are some of the more common medical problems that can develop:
Blood clots - You are at greater risk for clots if you suffered a stroke or fractured your hip. Most patients are given blood thinners (anticoagulants) during their rehabilitation to keep blood clots from forming.
Heart disease -It may come as a surprise that occupational therapy puts more stress on your heart and lungs than physical therapy. The reason is that exercising your arms elevates your blood pressure and pulse rate more than exercising your legs. If you suffer from heart disease any activity will be adjusted and your vital signs will be monitored regularly.
Joint problems - The progressive weight bearing involved in physical therapy can stress your joints and exacerbate your arthritis.
Lung disease - Your doctor will check your lung function if you have lung disease or experience shortness of breath during your therapy sessions.
Written by home care expert Mary S. Yamin-Garone.