How to Choose Between Rehab and Skilled Nursing
If your parent has been in the hospital because of chronic illness, injury, stroke or surgery, the next step may be a period of rehabilitation. Rehabilitation can take place at home, but often your parent’s situation may require a stay at a rehabilitation center in a skilled nursing facility. The outcome of the rehab depends upon a number of factors, including the availability of family support, the prognosis for recovery and your parent’s commitment to the rehab regimen.
Here’s how to determine the best path of healing for your senior loved one.
Establishing Rehab Goals
“The first and most important factor you should look at is the declining level of function of the patient and what the long-term goals are,” says Michael Feinberg, Director of Rehabilitation at RiverSpring Rehabilitation, located at the Hebrew Home in Riverdale, New York. “The second factor, which is also extremely important, is the psychosocial aspects of the patient.”
The psychosocial aspects relate to how motivated the patient is to achieving the rehabilitation goals. Feinberg has found that patients do better when they have input into establishing the goals written into the plan of care.
“That gives the patient the internal motivation necessary to achieve those goals. If a family member or therapist sets the goals too high and the patient doesn’t see them as achievable, their efforts might not be where they need to be. Motivation needs to an internal component. If you try to externally motivate, the results are not going to be the same.”
In most situations, patients will receive a more intensified level of rehab at a skilled nursing facility (SNF) than at their own home. “In an SNF, you’re going to receive an individualized clinically driven program five to six days a week, consisting of occupational, physical and speech therapy as indicated, whereas the home program is typically two to three days a week,” Feinberg explains. “So, from an intensity level, the SNF is going to be the higher level of therapeutic care. In theory, with motivated patients, your outcomes should be faster.”
Looking Toward Discharge
An important part of the rehab process is the discharge plan, which will determine when and whether a patient can return home safely. “Here at Hebrew Home, discharge planning is determined in conjunction with caregiver and family support and in reviewing the patient’s or resident’s prior level of function,” Feinberg says. “This allows us to determine what level the individual needs to be at in order to return to the community in a safe capacity.”
Feinberg cites as an example a person who has suffered a stroke. “If prior to the onset of the stroke, they were independent in lifestyle —driving a car or functioning at a very high level — that prior level of function is a baseline for what might or might not be achievable after the stroke. Let’s say that, after two or three weeks, they are independently able to get in and out of bed and can care for themselves at home with a walker.
At that point, after having conversations with the family about the support system available in the home and if a safe discharge can be put into place, we will facilitate that discharge plan and make recommendations for continued services at home.”
However, there are cases when it’s determined that the patient cannot return home safely. “Often it’s the patient or the resident who will express that they don’t feel safe at home. Other times, it will be the family that says, ‘We can longer provide the support our parent needs,’” Feinberg says.
In such circumstances, the patient may be admitted to the Hebrew Home as a long-term resident. The staff in the rehab unit works closely with those in the long-term care unit to ensure a smooth transition.
“If we know someone will be staying on a long-term basis, we will continue the rehabilitative efforts,” says Feinberg. “From a therapeutic standpoint, whether it’s creating a safe discharge into the community or creating a safe discharge in place, the goals are ultimately the same.”
About the Author
Diane Franklin is a freelance writer and editor who writes regularly about senior living and healthcare. She has also written hundreds of articles for business and trade publications, including leading magazines for the credit union and retail paint industries.
If you or a parent have gone through the rehabilitation process, tell us: what advice would you give other families? We’d like to hear your stories in the comments below.
We Can Help! Our local advisors can help your family make a confident decision about senior living.