Many facilities may have multiple services – often, the same facility will offer subacute rehab and long-term care and memory care services
Level of care dependent on the need of assistance as per PT/OT/Speech evaluation
Instrumental Activities of Daily Living (IADLs) = managing house, finances, transport, medications, shopping
Activities of Daily Living (ADLs) = walking, toileting, bathing, feeding, transferring
Starting to talk about rehab in the ED:
- Is this a rehab-able condition?
- Rehab-able condition examples: stroke, hip fracture, deconditioning after serious illness
- Potentially not rehab-able examples: any progressive, gradual degenerative disease in which the patient is expected to continue to decline
- Why does this matter?
- Insurance will stop paying for rehab if patient is not improving or making progress based on their PT/OT/ST notes
- There is a daily copay for patients after 21 days in rehab and the full cost is on the patient after 100 days
- PT is amazing but cannot fully reverse a months-long decline in 21 days!
- Will the patient be able to physically and cognitively participate in rehab?
- Acute inpatient rehab = 3 hours therapy/day
- Subacute rehab = 3 hours/week
- Patients are not rehabbed until they can go home safely – patients are rehabbed until they can safely live in a one-story home.
- So what is the goal after rehab? What is the backup plan if they still can’t go home after 21 days? Will they still need help?
References:
https://www.genworth.com/aging-and-you/finances/cost-of-care.html
https://www.medicare.gov/care-compare/
https://www.aarp.org/caregiving/
Flint LA, David DJ, Smith AK. Rehabbed to Death. N Engl J Med. 2019;380(5):408-409. doi:10.1056/NEJMp1809354
Flint LA, David D, Lynn J, Smith AK. Rehabbed to Death: Breaking the Cycle. J Am Geriatr Soc. 2019;67(11):2398-2401. doi:10.1111/jgs.16128
Burke RE, Jones J, Lawrence E, et al. Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care. J Gen Intern Med. 2018;33(5):678-684. doi:10.1007/s11606-017-4298-1
Halifax E, Bui NM, Hunt LJ, Stephens CE. Transitioning to Life in a Nursing Home: The Potential Role of Palliative Care. J Palliat Care. 2021 Jan;36(1):61-65. doi: 10.1177/0825859720904802. Epub 2020 Feb 27. PMID: 32106767; PMCID: PMC8127871.
