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Inpatient Rehabilitation

Acute Inpatient Rehabilitation v. Sub Acute Skilled Nursing Facility

When you are preparing for discharge from the hospital, your healthcare team may recommend continued care before you go home.   Going to “Rehab” after discharge can refer to Acute Inpatient Rehabilitation or rehabilitation in a Sub Acute Skilled Nursing Facility.  There are important differences which may not be clearly defined in the glossy brochures left at your bedside.  At a quick glance it appears that both types of Rehab offer therapy, physician and nursing care with programs designed for a variety of illnesses and post surgical recovery.  It is important that you understand the differences so that you and your family can better participate in making important decisions about your post hospital recovery plan.

What’s the Difference?

Difference between acute inpatient rehabilitation and sub acute skilled nursing facility

Acute Inpatient Rehabilitation Facility (IRF)

Because the IRF provides such a high level of intensive therapy as well as specialized nursing and physician care, Medicare and private insurances have established eligibility requirements for admission.  There are fewer requirements placed on sub acute programs.  The discharge planning team can assist you in determining if you are eligible for either type of Rehab program.

Skilled Nursing Facility / Sub Acute SNF

Sub Acute SNF programs are a part of the skilled nursing community which includes both short-term sub acute rehab and the residential portions of the Skilled Nursing Facility. Some facilities separate the two patient population rooms and therapy areas while others are comingled. In most instances,  the common areas such as dining and recreation are comingled.

Evaluations

Both types of facilities perform an evaluation shortly after arrival.  The sub acute evaluation will place each person in a category, which determines the amount and types of therapy minutes a patient will receive. The minutes allocated after evaluation can vary from a high of 12 hours down to a total of 45 minutes per week. Patients are re-evaluated and the therapy minutes adjusted on or around days 5, 14, 30, 60 and 90.  The IRF Evaluation is completed by the 3rd day.  The evaluation process helps the IRF target a discharge window of time for each patient.  Therapy is provided at least 3 hours a day at least 5 out of 7 days or 15 hours per week at minimum.  Each person is followed by a multidisciplinary team which meets formally at least every 7 days to address any barriers found which might change the discharge plan.   No changes are ever made in the amount of time patients receive therapy.

Medical care is available at both types of facilities.   The availability of physicians and nurses is quite different.  Medicare patients in the Acute IRF must be seen in person by rehabilitation physicians  (physiatrists) at least three times per week. At Holy Cross Hospital, patients are seen by a physiatrist every day during the week, and a physiatrist is available on the weekends as well.  By contrast, Medicare patients in some sub acute rehab SNF may not see a physician more than once a week or in some instances even longer.  If the IRF is a part of the acute care hospital, the patient will have their primary physician and any clinical specialists that followed the patient in the hospital available to them during their IRF stay. In the event of an emergency,  the services of a full acute care hospital are available without delay.

Nursing care in an acute IRF facility is available 24 hours a day by a registered nurse with special training in rehabilitation care. Sub Acute SNF facilities are required to provide a registered nurse at least 8 hours a day and a licensed nurse the remainder of the time. Any emergent medical circumstances require that the patient be transported to the nearest acute care hospital by ambulance.

At the Holy Cross Hospital Rehabilitation Institute, our inpatient rehab unit provides highly trained individuals working as a team to address the post acute care recovery of the individual. Specialists and primary care physicians familiar to the patient are able to continue any follow-up care, and there is a rehabilitation physician who provides daily medical management to each patient. Of course, not every patient requires this high level of intensive rehabilitation after hospitalization. 

Ask your case manager or physician to determine if you are a candidate for the Inpatient Rehabilitation Unit of Holy Cross Hospital. If you have any questions, call 954-351-5958.

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