Consider an In-Patient Rehab Facility Before You Suffer a Fall

Researching your options may help you avoid a dilemma in a crisis situation.

By Heidi Godman, Contributor
U.S. News & World Report

Don’t Wait to Suffer a Fall

Patient having physical therapy in hospital

Start with your insurance company and find out which facilities are covered under your plan.(ANDERSEN ROSS/GETTY IMAGES)

AS A SAVVY MEDICAL consumer, you may already know which hospital you’d go to in an emergency or which doctor you’d turn to for a particular procedure. But many people never plan where they’d go for a few weeks or months of in-patient rehabilitation to recuperate from a fall. That choice may not even occur to a family until Mom, Dad or a spouse winds up in the hospital. “The case manager comes in and says, ‘Look at these facilities and tell us where you want to go so we can start our paperwork.’ The family and patients are overwhelmed,” says Dr. Saket Saxena, a geriatrician at Cleveland Clinic.

But it may be time to give the scenario a little thought. This year 1 out of every 4 older adults will fall, according to the Centers for Disease Control and Prevention, and 20 percent of those people will suffer a serious injury, such as a broken hip or a head injury. While the best option is to go home after hospitalization for a fall, where you can rely on in-home or out-patient follow-up treatment, not everyone is well enough or has the support at home. It could help to know which rehab facility would be best for your family, should you ever need to stay in one.

What Are the Choices?

In-patient rehab is meant to be a temporary transition stage between the hospital and your return home. “After a fall, your ability to walk may be compromised. You may not be able to carry out the activities of daily living. You may need physical therapy and occupational therapy in order to go home again. Or you may have a wound that needs to be dressed every day,” explains Dr. Carla Perissinotto, associate chief for geriatric clinical programs at the University of California—San Francisco.

 There are two types of in-patient rehab facilities: acute care (in a stand-alone facility or within a hospital) and skilled nursing (beds within a nursing home that are intended for a short-term stay). Both have round-the-clock nurses and certified nursing assistants. Both kinds of facilities also have physical therapists and occupational therapists on staff.

But acute rehab is intense. It’s only for patients who can tolerate more than three hours per day of rehabilitation. This type of rehab facility has doctors and specialists (like physiatrists) on staff or on-site every day to oversee treatment (skilled nursing facilities typically have fewer visits from doctors) and has more services (such as prosthetics departments and wheelchair clinics) and equipment (such as X-ray machines or high-tech physical therapy equipment) than a skilled nursing facility.

Before you’re discharged from the hospital, your doctor and a hospital physical therapist will determine which type of in-patient rehab is most appropriate for you.

Shopping in Advance

Because the quality of care and services at in-patient facilities varies, you may want to do some comparison shopping well in advance of an emergency – especially when you’re healthy and able to make decisions without stress or pressure.

Start by using Medicare tools to look up available facilities and see how they compare. The Inpatient Rehabilitation Facility Compare tool will enable you to look for acute care rehab facilities and view information about the kinds of ailments they treat and the number of infections, complications and hospital readmissions they report.

The Nursing Home Compare tool enables you to search for skilled nursing facilities and see how they rate in inspections and quality of care. You can even see how many minutes each type of staffer (like a nurse or physical therapist) usually spends with a patient.

U.S. News also offers helpful tools to assist your search for information about rehab facilities and nursing homes.

Another idea: Start with your insurance company and find out which facilities are covered under your plan. From there, look up the ratings and services provided by each facility.

Once you find a few possibilities that interest you, consider visiting each one. “Go there and see how clean the facility looks and how friendly the people are. Ask to look at the rehabilitative space in terms of physical and occupational therapy and communal spaces for joint meals,” Perissinotto says. She also suggests that you consider a facility’s location. “If you have a choice, find a place that’s easy for your family to get to, so they can visit. Being in a rehab facility can be isolating.”

Saxena advises that you observe whether the staff seems overwhelmed, and recommends that you ask about the food (since patients may stay in a rehab facility for weeks or months).

Saxena also says it helps to consider a rehab facility that’s affiliated with your hospital. That way, the rehab facility physicians will have access to your hospital records and information about your treatment, medications, lab work and follow-up appointments that may be scheduled. “I think it helps in preventing many mistakes that can happen during the transition from the hospital to the rehab facility,” Saxena says.

The Best Laid Plans

Just because you have an idea of which facility you’d like to stay in, it doesn’t mean that there will be an available bed if you ever need it. Space may be limited at the facility you prefer. “Sometimes you just have to go where the bed is available,” Perissinotto says.

Your hospital caseworker will make sure a rehab facility has space for you and takes your insurance, if you haven’t already learned that information.

But both Perissinotto and Saxena say it’s reasonable to have some preferences for certain rehab facilities in your area, and to use those preferences as a starting place. For example, maybe through advance investigating you learn about a facility near your home that has a great reputation for care and the best food in town. Or you may learn about a facility not far from home that has the latest high-tech machines used in physical therapy. Knowing that information would help you make an informed decision, should the need ever arise. At the very least, it may be help ease a very stressful situation.

“We can’t recommend a facility. It’s all the patient’s choice,” Saxena says. “It’s a critical decision, and it’s a lot to handle for the patient and the family members.”

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