Making Post-Hospital Rehabilitation Choices

Let’s face it, being in the hospital is not among anyone’s favorite things. But when faced with illness or injury, hospitals provide the latest in medical care and services needed to help you recover. Nursing care around the clock, immediate access to lab, x-ray and other more advanced diagnostics allow immediate response to life threatening changes in your condition. Intensive therapies, including respiratory and physical therapy, help your body to function while it recovers from the shock of illness or trauma. All this is designed to help you stabilize and begin to feel better and regain the necessary functions you’ll need to leave the hospital.

Many people are discharged by their doctors and allowed to go home, but sometimes home is not the best or safest place to be immediately following a hospital stay. You may not be ready to:

• Get in and out of bed by yourself
• Sit down and get up form a chair by yourself
• Get bathed and dressed alone
• Safely use a walker, cane or crutches
• Walk between bedroom, bathroom and kitchen
• Walk up stairs
• Drive, shop or prepare a meal

Often doctors recommend a stay at a rehabilitation or post-acute care facility for further recovery. This often follows joint replacement surgery, stroke, cardiac or pulmonary event or after a particularly long hospital stay. Just recovering from surgery or a serious illness can be stressful and difficult, especially as we age. Wounds and incisions may not heal as quickly as they used to. Therapies may involve more invasive treatments and medications. When you’re at a specialized facility, these issues are addressed without having to arrange special care.

If you have chronic medical problems like heart disease, diabetes or lung problems, recovery following a hospital stay can be more complicated. You have to learn to manage these conditions to facilitate your recovery and stay healthy, so a stay at a rehabilitation facility can be a major contributor to returning to a more normal life.

Recent research by the American Journal of Managed Care illustrates the necessity of good post-acute care. They surveyed adults 55 and over who were discharged from a hospital and prescribed post acute care services. The survey results showed about 30% of these people refused rehabilitation or post-acute care services. Those individuals:

• Ranged in age from 68 to 73
• Were more likely to be married and have private health insurance
• Were less ill than those who chose to go to a rehabilitation facility
• Had shorter hospital stays

Following discharge from the hospital, the survey showed that most people, whether they go home or to a specialized care facility, will experience:

• Pain or discomfort - 41%
• Problems with mobility - 46%
• Inability to perform normal activities - 52%
• Problems with household activities - 67%

However, the study also shows that individuals who choose not to follow their doctor’s recommendation to recover in a post-acute care setting were twice as likely to require another hospital stay at 30 and 60 days post-discharge. This was in spite of the fact that the patients at home were younger and not as sick as those who went to post-acute care. The aggressive rehabilitation program at a specialized care facility helps to improve function and outcome overall. The Agency for Healthcare Research and Quality did research in 2011 that looked into the reasons for readmission to the hospital. For Medicare patients, the five most common reasons for readmission to the hospital were:

• Congestive heart failure
• Septicemia
• Pneumonia
• Chronic obstructive pulmonary disease
• Cardiac dysrhythmias

These are all serious conditions, so it makes sense to do all you can to avoid returning to the hospital and maximize your ability to recover safely and efficiently.

Besides your health condition, you should consider the ramifications of choosing to recover at home instead of a rehabilitation facility. Do you have someone to care for you at home? Do you know all of the responsibilities that go along with taking care of someone? You may need help with everything from dressing to going to the toilet to brushing your teeth. And don’t forget about meal preparation, laundry, grocery shopping, house cleaning and everything else that daily living involves. Does your spouse or adult child have the time and physical abilities to manage all of that? Many people, both caregiver and patient, underestimate the physical and emotional toll of caring for someone recovering from a serious medical issue. It can have a serious, negative impact on the caregivers, endangering their own health and well-being.

And then there are the misconceptions about what a post-acute care setting is about. Lots of people imagine a stereotype nursing home from years ago that only catered to elderly long-term residents. Nothing could be further from the truth. Nursing homes today are specialized facilities that provide care and assistance with the needs of daily living for those who need to relearn or adjust their lifestyle before managing on their own. Many of the patients have a goal to return home or to a lower level of care.

A skilled nursing and rehabilitation facility is where individuals go now to recover from surgery or other serious medical condition before returning home. Nurses and other health care specialists provide pain management, respiratory therapy, physical therapy, occupational therapy, speech and language therapy and other ancillary services. They can also supervise medication and provide injections, IV medicine and other specialized services. Support systems and assistance for caregivers and family are usually available as well. All of this contributes to an intensive recovery experience that is designed to help you return home as quickly and safely as possible.

Rehabilitation facilities are licensed by the state, and certified and regulated through the federal government. Medicare covers a stay of up to one hundred days, and private insurance usually offers coverage as well. Recovery will continue at home, and you may still need to have some home health care services, but the time you spend in a skilled nursing rehabilitation facility is the ideal way to jump start your road to recovery.