Rehabilitation therapy can be a blessing after being hospitalized for a stroke, a fall, an accident, a joint replacement, a severe burn, or a spinal cord injury, among other conditions.
Physical therapy, occupational therapy, and speech therapy are offered in various settings: hospitals, nursing homes, clinics, and at home.
It is essential to find a safe and high-quality option with experienced professionals in treating your condition.
What types of rehabilitation therapy might you need?
Physical therapy helps patients improve their strength, stability, and movement, and reduce pain, usually through specific exercises.
Some physical therapists specialize in neurological, cardiovascular, or orthopedic problems. There are also specialists in geriatrics and pediatrics. Occupational therapy focuses on specific activities (called “occupations”), which often require fine motor skills, such as brushing teeth, cutting food with a knife, or dressing.
Speech therapy helps people communicate. Some patients may need respiratory therapy if they have difficulty breathing or need ventilator withdrawal.
Do insurance plans cover rehabilitation sessions?
Medicare, health insurers, workers’ compensation, and Medicaid plans in some states cover rehabilitation therapies, but plans may refuse to pay in certain settings and limit the number of sessions.
Some insurers may require preauthorization and others may cancel coverage if there is no improvement. Private insurers typically set annual limits for outpatient therapy.
Traditional Medicare is usually the least restrictive, while Medicare Advantage plans may closely monitor progress and limit the locations where patients can receive therapy.
Should I seek hospital rehabilitation?
Patients who still need medical or nursing care but can tolerate three hours of therapy five days a week may qualify for admission to a specialized rehabilitation hospital or a unit within a general hospital.
Patients usually need at least two of the main types of rehabilitation therapy: physical therapy, occupational therapy, or speech therapy. Stays typically last about 12 days.
How do I choose?
Look for a center specialized in treating people with your diagnosis; many hospitals list specialties on their websites. People with complex or severe medical conditions may prefer a rehabilitation hospital connected to a cutting-edge academic medical center, even if it is a flight away.
“Patients will see young patients with catastrophic injuries,” such as spinal cord damage, traveling to another state for treatment, said Cheri Blauwet, medical director of Spaulding Rehabilitation in Boston, one of the 15 hospitals that the federal government has praised for its innovative work.
However, choosing a hospital near family and friends who can help after discharge has its advantages. Therapists can help train caregivers at home.
How do I find rehabilitation hospitals?
The discharge planner or social worker at the acute care hospital should offer you options. You can search for inpatient rehabilitation centers by location or name on the Medicare Care Compare website. There you can see how many patients with your condition that hospital has treated; the more, the better.
You can search by specialty through the American Medical Rehabilitation Providers Association, a trade group that publishes a list of its members.
Find out what specialized technologies a hospital has, such as driving simulators (a car or truck that allows the patient to practice getting in and out of a vehicle) or a kitchen table with utensils for practicing cooking.
How can I tell if a rehabilitation hospital is reliable?
It is not easy: Medicare does not analyze staff or publish safety inspection results on its website like it does with nursing homes. You can ask your state health agency or the hospital to provide you with inspection reports from the past three years. These reports may be technical, but they will help you understand the essentials. If the report indicates an “immediate jeopardy” was declared, it means that inspectors identified safety issues that endanger patients.
The rate of patients readmitted to a general hospital for a potentially preventable reason is a key safety measure. In general, for-profit rehabilitation centers have higher readmission rates than non-profit ones, but there are some with lower readmission rates and others with higher rates. You may not have another option nearby: there are fewer than 400 rehabilitation hospitals and most general hospitals do not have a rehabilitation unit.
You can find a hospital’s readmission rates in the quality section of Care Compare. Rates below the national average are better.
What if I cannot tolerate three hours of therapy per day?
A nursing home that offers rehabilitation may be suitable for patients who do not need a doctor’s supervision but are not ready to go home. The facilities generally provide 24-hour nursing care. The duration of rehabilitation varies depending on the patient. There are more than 14,500 skilled nursing centers in the country, 12 times more than hospitals offering rehabilitation, so one of these nursing homes may be your best option.
You can search for them through the Medicare Care Compare website.
What if patients are too frail even for a nursing home?
They may need a long-term care hospital. These specialize in patients in a coma, on ventilators, and with acute medical conditions that require a doctor’s presence. Patients stay there for at least four weeks, and some for months. Care Compare helps you search. There are fewer than 350 hospitals of this type.
If I have enough strength to go home, how do I receive therapy?
Many rehabilitation hospitals offer outpatient therapy. You can also go to a clinic or have a therapist come to your home. You can hire a home healthcare agency or find a therapist that accepts your insurance and makes home visits.
Your doctor or hospital may refer you to other professionals. In Care Compare, home healthcare agencies indicate if they offer physical therapy, occupational therapy, or speech therapy. You can search for certified therapists on the American Physical Therapy Association (APTA) website.
During rehabilitation, patients sometimes move from the hospital to a nursing center and then home, often at the insistence of their insurers. Alice Bell, senior specialist at APTA, noted that patients should try to limit the number of transfers for their own safety.
“Every time a patient moves from one environment to another, they are in a higher-risk zone,” she said.
