My client was recently hospitalized for less than a week, and then transferred to a “rehab” facility, as described by her husband. “She needs rehab”, her husband exclaimed, “she can’t walk”. After hospitalization, she declined rapidly. At the “rehab” facility, she needed oxygen at all times. She spent most of the day sitting in a wheelchair next to the bed. She received about an hour of physical therapy a day, her only opportunity to walk. At home before hospitalization, she walked frequently around the house.
People often confuse inpatient rehabilitation facilities (IRF) and skilled nursing facilities (SNF), lumping both into the term “rehab”. Admission to a SNF requires a qualifying three day hospital stay, and the need for either daily skilled nursing or therapy. Medicare pays for up to 100 days in a SNF. On the other hand, an IRF has no hospital stay requirement, but the patient must tolerate three hours of intense rehabilitation services (combination of physical, occupational, and speech therapy) per day. IRFs are free standing units in hospitals, and have the same Medicare coverage benefits as inpatient hospitals.
Average length of hospital stay declined from 10 days in 1980 to six days in 2014 when Medicare implemented a payment system where hospitals get reimbursed a fixed amount per episode of care. Over the past 30 years, the proportion of Medicare patients discharged from a hospital to a SNF increased from 5% to 20% as hospitals rely more on SNFs to transition patients home. Hospitals have not shifted Medicare discharges from SNFs to lower cost home health care despite evidence of similar outcomes. Studies also show no difference in outcomes between intensive rehabilitation at an IRF and therapy at home after joint replacement surgery.
Considering similar outcomes and equal accessibility across discharge options, and the lower financial burden of home care, home health tops the discharge option list, unless otherwise specified by client or caregiver.