Monday Back to Basics

Let’s talk about Rehab with Dr. Katie Selman

Many facilities may have multiple services – often, the same facility will offer subacute rehab and long-term care and memory care services

Instrumental Activities of Daily Living (IADLs) = managing house, finances, transport, medications, shopping

Activities of Daily Living (ADLs) = walking, toileting, bathing, feeding, transferring

  • 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?


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. 

Leave a Reply

Your email address will not be published. Required fields are marked *