Gonna make me go to rehab…


Having an operation is a big deal. Your body needs time to heal from the effects of an operation, even if it’s a comparatively minor or minimally invasive procedure. If you have a bigger operation, have complications from your operation, or go into your operation already sick, you may need quite some time – weeks or even months – to heal before you’re ready to go home. That means that you may find yourself medically well enough to leave the hospital but not well enough to go home independently. In that case, you may need to spend time in a rehab center or skilled nursing facility (SNF), or get home health services.

Let’s start with some definitions:

Inpatient rehabilitation: Inpatient rehab is the highest level of rehabilitation that you can get after an operation. In these centers, which are often part of larger hospitals, patients participate in at least three hours of rehabilitation therapy every day. These programs work well for patients who are able to do exercises for at least three hours per day, such as young, healthy people with traumatic injuries, but are not a good fit for patients who have been extremely ill and aren’t ready for intensive physical therapy.

Skilled nursing facilities (SNFs): You may hear your medical team refer to these facilities as “Sniffs.” They offer an assisted care environment that is less intensive than inpatient rehab centers, but still provide help with physical therapy, walking, and the basic activities of daily living (eating, toileting, etc.) SNFs can also provide wound care and a variety of nursing services, such as oxygen therapy, IV medications, and nutritional support. Many patients think of SNFs as “nursing homes,” and while that’s technically true, there is a big difference between the SNFs where patients go for a short time after surgery and the traditional image of a nursing home as a place where elderly people live out their lives.

Home health: A variety of home health services are available, and include nurses and other healthcare professionals coming to a person’s home to provide wound care, medication infusion, and physical and occupational therapy. Home care services are great for patients who need a little extra help, but are not enough for patients with significant medication, wound care, or physical/occupational therapy needs that require daily management. While it’s possible to hire 24-hour in-home nurses, insurance companies typically only pay for these services if you need them just a few times per week.

Why Would a Patient Need These Services?

Your medical team considers many things to decide whether you’re safe to go home after an operation. The most important factor is whether you’re able to take care of yourself. That’s an assessment made by your doctors and nurses, and by the hospital physical and occupational therapists, who are specially trained to measure patients’ abilities to get in and out of bed, get to the bathroom, and take care of basic household tasks. If they don’t think you’re up to the task, they’ll recommend you go to inpatient rehab or a SNF. If they think you can manage at home, they’ll recommend home health. Your surgeon is unlikely to go against the recommendation of the physical and occupational therapists, so when they come by to evaluate you, it’s important that you participate as much as possible.

Inpatient rehab is managed by specialist physicians known as physical medicine and rehabilitation specialists or physiatrists. If your inpatient medical team thinks that you might qualify for inpatient rehab, they’ll have these specialists evaluate you for possible admission to a rehab center.

Of course, all of these services cost money. Much of the time, insurance companies, including Medicare and Medicaid, are willing to cover the cost because it is less expensive than staying in the hospital for long periods of time. But every person’s insurance situation is different, and any individual’s plan can be extremely complicated to figure out. The person in charge of determining what your insurance will cover, and which facilities will accept your insurance, is the hospital social worker. Social workers are a great resource in the hospital for all sorts of things (look for a post on this in the weeks to come), and helping patients find rehab or SNF placement is one of their biggest jobs.

Tips for Choosing the Right Facility

So, let’s say you need to go to an inpatient rehab or skilled nursing facility. Hopefully you’ll have a few to choose from. Here are some things to keep in mind:

Ask your family or friends check them out for you. You’ll want a place that feels comfortable, but unless you plan well in advance, you may not be able to visit potential facilities yourself. Enlist your family and friends to check them out for you and report back.

Make sure the facility can accommodate your needs. Your medical team will help with this, but you should confirm that any rehab or SNF can provide appropriate services, such as dialysis, complex wound care, IV nutrition, or specialized physical therapy.

Look for a facility that can accommodate your special circumstances. If possible, it may be helpful to be in a facility near family or friends. If you will need many follow-up appointments with your doctors, a facility close to the hospital may be preferable. Also, many nursing facilities are affiliated with religious organizations, so you may want to look for a place that’s part of your denomination.

Needing to go to a rehab facility or SNF is not something that anyone wants to do. But by preparing for the possibility, talking with your medical team and hospital social worker early, and working closely with the physical and occupational therapists in the hospital, you’ll be doing everything you can to make sure that your time recovering from your operation is as fast and smooth as possible.

This story originally appeared in the  Health Dialog Care Compass Blog.

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