Navigating the spectrum of elder care options can be confusing, even if an aging loved one doesn’t have a pressing need for support. There are many kinds of long-term care that involve different levels of supervision, medical care, personal care and costs. The settings in which these services are provided differ widely as well.
But, when an older adult is ready to be discharged from the hospital and needs rehabilitation in a safe and supportive environment to recover fully, family members often stress over this time-sensitive decision. Understanding the differences between senior rehab settings, the types of care they provide, how they can be paid for, and how some of these options overlap will prevent headaches when trying to find the best rehabilitation center for an elderly loved one.
What Is Senior Rehab Care?
Short-term rehabilitative care is ordered by a doctor for a patient who requires extra support and supervision to help them recover from an illness, injury or surgical procedure. This type of care helps patients regain as much of their physical and functional abilities as possible, which would be difficult (if not impossible) to accomplish on their own. Senior rehab is commonly needed to facilitate recovery from a stroke, heart attack, traumatic brain injury, joint replacement, hip fracture, amputation or pulmonary disorder. Most older adults pay for this care using a combination of Medicare Part A benefits (which are limited) and private funds.
In any elder care situation, understanding the services a senior requires will help you decide what care settings best fit their needs. By default, senior rehabilitation services involve the highest level of care: skilled care.
According to Medicare.gov, skilled care “includes skilled nursing or rehabilitation services to manage, observe, or assess a resident’s care. Examples of skilled care include occupational therapy, wound care, intravenous (IV) therapies, and physical therapy.” Skilled care can only be provided by or under the supervision of a registered nurse or doctor.
Where Can Senior Rehabilitation Be Provided?
One main difference between senior rehab care options is where they are provided. Of course, the setting also corresponds with the level of skilled care a patient requires.
Home Health Care and Outpatient Rehabilitation
Younger individuals and seniors who are recovering from more mild health issues typically recuperate well at home while receiving skilled nursing and therapy services intermittently. Skilled care can be provided in the comfort of a patient’s own home (known as home health care services) and in doctor’s offices and/or physical therapy centers (known as outpatient rehabilitation). A senior must be mobile and have transportation to regular appointments to be a candidate for outpatient treatment.
Keep in mind that a senior must agree to participate in rehabilitative services, and continue exercises at home to maintain their progress. Elderly individuals, particularly those who live alone, are less likely to get high quality results from outpatient rehabilitation services.
Inpatient Rehabilitation Settings
When an elder’s condition prevents them from being safely discharged to their home right away, some form of inpatient rehabilitative care is usually necessary. Inpatient rehab involves a formal admission to a hospital or other health care facility for a temporary stay that may last anywhere from a few days or weeks to a few months. There are two levels of inpatient rehabilitation.
Subacute RehabilitationThis is the type of senior rehab that most elders and family caregivers are familiar with. A subacute rehabilitation program consists of one or two hours of therapy per day—usually a combination of physical, occupational and speech therapy.
Subacute stays are typically longer than stays in acute rehab but are still temporary. Patients receive skilled nursing care and personal care (assistance with activities of daily living) as needed and are seen by a physician approximately every 30 days during their stay.
Acute RehabilitationThe Glancy Rehabilitation Center in Duluth, Georgia, defines acute rehabilitation as an intensive multidisciplinary rehab program for patients who have a debilitating disease, have sustained traumatic injuries, had a severe stroke or had an intensive surgery like amputation. During their stay, patients receive at least three hours of therapy per day for up to five days per week. Nursing and personal care are also provided, and patients are seen by a physician daily.
Common Senior Rehab Terms Defined
Unfortunately, the terminology used to describe inpatient settings is often confused with long-term care options. Remember, senior rehabilitation is only provided on a temporary basis to assist in a patient’s recuperation. The following definitions and explanations will help older adults and their caregivers understand the differences and similarities between short-term rehab settings and long-term care settings.
A nursing home is a facility that provides around-the-clock supervision, custodial care and nursing care for seniors who cannot be cared for at home. Some nursing homes focus on caring for long-term residents, but many also have a separate rehabilitation unit or program for patients who require skilled nursing care and various types of therapy. For this reason, many seniors transition from the hospital into a nursing home to receive their rehabilitation services, even if it is only for a short-term stay.
The Centers for Medicare and Medicaid Services (CMS) place both “skilled nursing facilities” and “nursing facilities” under the “nursing home” umbrella.
Skilled Nursing Facility (SNF)
CMS defines a skilled nursing facility as a nursing home that is certified by both Medicare and Medicaid, meaning they provide both subacute rehab and long-term care. When it comes to short-term rehab care, a 2014 study commissioned by an affiliate of the American Medical Rehabilitation Providers Association (AMRPA) found that the average length of stay for Medicare patients in SNFs is 26.4 days. (Keep in mind that Medicare only covers 100 percent of SNF costs for the first 20 days of a patient’s stay.)
Since SNFs accept both Medicare and Medicaid as well as private pay, a patient who still needs services after exhausting their 100-day Medicare benefit period may have the option to become a permanent resident. SNF residents often pay privately for ongoing services or spend down their assets and income to become eligible for Medicaid coverage of their extended stay.
Even though SNFs do accept Medicaid, facilities often limit the number of “Medicaid beds” that are available to residents. If a Medicaid bed is not available in a patient’s current SNF, then they will need to move to another facility with an open Medicaid bed when their rehabilitative stay is complete.
Nursing Facility (NF)
CMS defines a NF as a nursing home that is only certified by Medicaid. According to Medicaid.gov, if a nursing home accepts Medicaid, a Medicaid eligible patient who is ready to transition to long-term care may stay in the same facility where they received rehabilitative care. However, a rehabilitation facility that is not Medicaid certified will require that a patient transfer to a Medicaid Nursing Facility to be covered by the Medicaid NF benefit.
Senior Rehabilitation Center
This term can describe a stand-alone facility that only provides short-term skilled nursing care and rehabilitative care for patients or it can refer to the rehabilitaion unit within a nursing home. Senior rehab centers provide subacute care.
Inpatient Rehabilitation Facility (IRF)
CMS defines an IRF as “a freestanding hospital or part of an acute care hospital that provides an intensive rehabilitation program for patients.” IRFs are also called acute care rehabilitation centers or rehabilitation hospitals. Patients must be able to tolerate (and willing to participate in) acute rehabilitation care. This very high level of care is overseen 24/7 by an interdisciplinary team that includes a physician and nurses who specialize in rehabilitation medicine. The same 2014 study cited above found that the average stay for patients in IRFs is only 12.4 days.
Finding the Right Senior Rehab Plan
Choosing an elder care provider is always challenging, regardless of whether an aging loved one only needs temporary services or is looking for a new home in a long-term care facility. Understanding that these two care decisions are closely intertwined makes choosing the right location very important. Do not hesitate to ask your loved one’s doctor questions about their current and future care needs. Request a meeting with a hospital social worker to discuss discharge planning, and be sure to make in-person visits to evaluate rehab options. When family caregivers do their part to learn about the types and levels of care available to seniors, they become better advocates for their care recipients.
Sources: What’s Home Health Care? (https://www.medicare.gov/what-medicare-covers/whats-home-health-care); Home Health Services Coverage (https://www.medicare.gov/coverage/home-health-services); What Is Inpatient Care? (https://www.medicareresources.org/glossary/inpatient-care/); Acute vs. Subacute Differences (https://www.gwinnettmedicalcenter.org/services/rehabilitation/glancy-rehabilitation-center/acute-subacute-differences); Medicare Nursing Home Compare Glossary (https://www.medicare.gov/NursingHomeCompare/Resources/Glossary.html); Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge (https://amrpa.org/Portals/0/Dobson%20DaVanzo%20Final%20Report%20-%20Patient%20Outcomes%20of%20IRF%20v_%20SNF%20-%207_10_14%20redated.pdf); Inpatient Rehabilitation Facilities (https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/InpatientRehab); Inpatient Rehabilitation Care Coverage (https://www.medicare.gov/coverage/inpatient-rehabilitation-care); Levels of Rehabilitation Care (https://cdn.ymaws.com/www.physiatry.org/resource/collection/180DD800-48B0-4BAA-AD14-1C71F539B8C7/Levels_of_Rehabilitation_Care.pdf)