Post-Hospital Rehabilitation and Patient Choice

In today’s healthcare landscape, the term “patient choice” is used a lot. But realistically, how often is that truly the case? Older patients, in particular, who are hospitalized and unable to return home safely on their own or with a family member, must often make a difficult decision about their post-hospitalization needs. This can be tricky, and patient choice can be a challenge for a number of reasons. Not knowing your options, timing, and your insurance coverage can contribute to the uncertainty. If you cannot be discharged safely back to your home and placement is recommended, you may start asking the following questions: 

  • What are my options? 
  • What’s the difference between those options?
  • Which is right for me?
  • Will my insurance pay for it? 
  • Is this truly short-term? Will I be able to return home?

Post-discharge Options

First, your options are based on your needs. The next step could be a Long-Term Acute Care Hospital (LTACH) or long-term nursing placement. Or, you may just need some short-term inpatient rehabilitation to regain your strength, balance, and mobility. If so, physical, occupational, and speech therapy can help bring you back to your baseline (or as close to it as possible) after an injury or illness. For short-term rehab there are two primary choices: acute rehab or “sub-acute” nursing rehab.  

Acute rehabilitation is usually for those who need very intensive, multidisciplinary rehabilitation after a traumatic injury, severe stroke, or after having acquired a debilitating disease. In an acute rehab hospital, patients receive at least 3 hours of therapy per day, for up to five days a week. It’s a great option, but for many, it can be too intense and too fast paced. Therefore, sub-acute rehabilitation is a great alternative, especially for older and frailer individuals. Generally, patients would receive 1-2 hours of therapy each day, which is more moderately paced and typically equates to a longer inpatient stay.

Because sub-acute rehab is normally offered in nursing care facilities, there can be a stigma. But these rehabilitation programs have greatly improved over the years. The misconceptions are fading and the care and the environment have come a long way. Many offer high-quality, well-paced, amenity-filled rehab stays. Most often, rehabilitation programs within a “nursing home” are separate from long-term nursing with dedicated areas for short-term rehab patients. 

For instance, Messiah Lifeways® at Messiah Village’s Wagner Transitional Care features private rehab rooms with private bathrooms, a state-of- the-art rehab gym and private treatment rooms. The campus also offers a number of amenities that make a necessary and sometimes trying period a little more pleasurable. Individuals have access to a restaurant, coffee shop, gift shop, hair salon, chapel, and other amenities. Most importantly, the in-house physicians, medical staff, and highly trained physical, occupational therapists, and speech pathologists are focused on getting individuals back on their feet and home as quickly as possible.

So how do you know which is right for you? The good news is that you don’t have to figure this out on your own. The attending physician, nursing staff, and therapist in the hospital will evaluate your needs and recommend the type of inpatient rehabilitation that is necessary after discharge. They may also recommend long-term nursing or personal care/assisted living placement if it’s obvious that a return home is completely out of the question. The healthcare evaluation along with your buy-in and ultimately the physician’s written order will assure the right level of rehabilitation is recommended. It should also be noted that if rehab is medically necessary as deemed by the doctor, the accepting rehab provider, and your health insurance, then the rehab stint should be covered under your insurance. Additional costs or copayment are dependent on your policy coverage.

More Choices

Despite having the physician’s order, picking the right inpatient rehab provider becomes your next challenge. Sometimes you have less than a day to figure this out. Taking a suggestion from the doctor or therapist can be helpful. The hospital social worker or case manager may also weigh in, but you should be offered a list of options. Remember, in the end – it is your choice. Quite often with a sudden hospitalization it can be hard to choose and coordinate the right placement. But if you (or a loved one) are able to do a proactive search because it’s a planned surgery or slower-paced hospitalization, then do it and then speak up. Tell the social worker or case manager that you would like them to make a referral to the sub-acute or acute rehab (as prescribed by the doctor) that you feel most comfortable with. Often patients feel like they have no choice in the matter. Please remember you have the right to choose.

For more information about Wagner Transitional Care, please contact the Welcome Center at 717.790.8201 or visit MessiahVillage.org/rehab.

Matthew J. Gallardo

Matthew J. Gallardo

Matt is the Director of Community Engagement and Coaching at Messiah Lifeways. He brings nearly 20 years of experience in counseling, advocating, and guiding older adults and caregivers through many of life’s tough decisions. His diverse background of working in hospital and rehabilitation settings, community services, and senior housing gives him the breadth and depth of knowledge to provide unique solutions, opportunities, and help individuals proactively plan for the future. He serves as the Lifeways Coach and as a writer, blogger, podcaster, and speaker for Messiah Lifeways, located in Mechanicsburg, PA.

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