Rehabilitation Residence

In the event that your loved one may be unable to return to their former home without a stop at a rehabilitation residence, here are a few items to keep in mind: 

Selecting a Rehab Facility

A few days prior to discharge the case manager will reach you to introduce themself.  At this time, they will explain the physician's recommendations for treatments and what services will be required.  The case manager is your advocate with Medicare and any supplemental insurance plan you may have and will explain what services are or are not covered by your insurance. If the patient needs to spend time at rehab, it is appropriate at this time to request a private room at a facility, especially if the patient presents with dementia or cognitive decline.  Within a few days the planner or case manager will provide you with a list of available rehabilitation centers that have beds available for you.  You will be given a window of time (about 48 hours) in which to decide a first, second and third choice selection.   

***TIP - While rankings (Medicare.gov) are important to evaluate a rehab center, the most important qualification is its proximity to the caregiver who is most likely to visit. More than ever, the patient will need an advocate who can be present at the rehabilitation residence.   

Arriving at the Rehab Residence

Be aware that rehab facilities are essentially nursing homes.  So do not be surprised when you walk in the door, and they are not quite what you might expect a therapeutic residence to be.  And if you arrive on the weekend, physical and occupational therapy services may not begin until the work week. 

This is also yet another unfamiliar location.  The patient who has had a long hospital stay will need to be bathed, groomed and checked for bed sores. Clothes and personal effects need to be brought in, and need to be monitored as they are washed and returned by staff.  Sleeping patterns, eating and behavior will once again be off kilter.  Sundowning is extremely prevalent and if mobile, patients are known to wander. Expect to spend extra time with your loved one these first few days to help them get acclimated and comfortable.  Get to know the staff that will be with them on a regular basis.  They may ask about patients' interests, behaviors and past level of cognitive abilities to assess what is injury induced vs patient normative.

“A note about guilt - You will feel guilt as a caregiver, especially if you are unable to care for your loved one in your home.  You may project that guilt into criticism of the quality of your loved one's care residence - regardless how excellent it is. The food is awful, the nurses not attentive, the facilities unkept, etc.  Be aware of this.  Take a deep breath. Advocate as much as you can, while recognizing the limitations of the people who are providing care for your loved one 24/7.” - Caregiver from a Distance

Leaving the Rehab Residence 

Typically Medicare coverage for rehab residences lasts about 21 days or  3 weeks. (Usually stay length is determined shortly after arrival.) After that time, patients are required to pay out of pocket per day.  Many people will be involved with the discharge from rehabilitation including a Medicare representative.  

Make sure to ask exactly what home care services will and won’t be covered post illness once your loved one returns home.  This may require getting written assessment records from the rehab Physical Therapy/Occupational Therapy (PT/OT) staff prior to discharge or upon their arrival back home. Typically, senior or assisted living residences will have partnerships with companies for ongoing pt / ot providers on site, as well as home-care nursing, but make sure to ask for multiple referrals before leaving the rehab center.