Leaving after a hospital stay doesn’t always mean everything returns to normal. The month, or months, after a hospital discharge represent a high-risk period. Seniors who are coming home from the hospital often require care and support in the form of rehabilitation services, such as physical therapy, occupational therapy or nursing care until they’re fully recuperated.
It’s important to understand the available options and other issues that need to be considered when deciding upon the best course of care for yourself or your loved one.
Hospital discharge planning
Only a doctor can authorize release from the hospital, but the actual process of discharge planning can be completed by a social worker, nurse, case manager, or other qualified person. Ideally, it’s done with a team approach.
The most important factor in determining where to complete rehabilitation is to find a setting that will reduce the risk of hospital readmission while you or your loved one regains strength, confidence and independence. Determining the best location for rehabilitation will also depend on your family situation, personal preference and the availability in your area.
There are three primary senior rehabilitation options available:
- Skilled nursing facility (SNF)
- Senior rehabilitation center
Each has its own rules, regulations and entrance requirements.
If you or your loved one needs only intermittent rehab or skilled nursing services, such as wound care or monitoring of medications and equipment, home health care may be the right option. Home health services are provided by licensed medical professionals who come to the home to do a specific task that has been ordered by a physician.
If you’re going to need professional assistance, such as a physical therapist or a home health aide, ask during discharge whether a case manager or social worker could help line up such assistance. Your provider, whether a doctor or a nurse practitioner, can also help you find health care professionals if needed.
Rehabilitation therapy provided by home health generally can only be offered a few times a week. Keep in mind that for many patients to have a successful outcome, they must be motivated to exercise when the therapist isn’t present. In-home therapies also lack the peer support and socialization that can be provided in skilled nursing facilities and assisted living communities. That support and socialization often gives seniors extra motivation as they recuperate.
Skilled nursing facility
Skilled nursing facilities, also referred to as rehab hospitals or nursing homes, are for people who require 24-hour nursing services and skilled medical care. They’re typically the best places to be if the patient’s doctor orders inpatient services, or if the patient will benefit from specialized treatment following the hospital stay, such as intensive physical or speech therapy.
SNFs offer short-term rehabilitation stays that may be covered by Medicare, for up to 100 days. To have a stay covered by Medicare, the patient must enter a Medicare-approved SNF within 30 days of a hospital stay that lasted at least 3 days. If the patient is confined to a bed, or requires extensive nursing services, a skilled nursing facility is the best option.
Senior rehabilitation center
If your loved one’s rehabilitation needs aren’t acute and don’t require inpatient services, they may be able to take advantage of outpatient services. The patient must be able to travel for after-care needs to be met by a short-term rehab center or an adult day health center. Typically, outpatient rehabilitation centers provide physical, occupational, and speech and language therapies.
Sometimes the need is for additional services beyond those provided at the rehabilitation center. Often, a combination of outpatient rehabilitation services and in-home care services works well in this scenario. Also keep in mind that it’s common for top rehab facilities to have waiting lists, so it’s important to start early to find a center that will accept the patient when they’re ready to be discharged from the hospital.
A continuum of care in one place
Some senior living communities combine skilled nursing and senior rehabilitation, as well as assisted living, services under one roof. Having all these levels of living on one campus allows people to transition from level to level with ease and peace of mind. Communities that offer skilled nursing care, assisted living, and rehabilitation are well versed in customer service and patient care. They’re able to balance the continued care for patients between levels of service and have an expert understanding of the documentation associated with each level of care. Also, because they so frequently deal with hospital referrals, admissions often happen more seamlessly.
Regardless of the type of facility you choose, always do your research. Don’t be afraid to ask the tough questions:
- How did they rank in their CMS (Centers for Medicare & Medicaid Services) rating? This is an overall rating of 1 to 5 stars to indicate the quality of many medical/health care services.
- How did they score on the last state inspection?
- Do they provide the specific care you need?
- Is the facility clean, well kept, quiet, and a comfortable temperature?
- Do you feel comfortable putting your or your loved one’s care in their hands?
Right here in Redding
Some communities offer private rooms for support following a hospital stay in Fairfield County, Connecticut. Ridge Crest at Meadow Ridge offers the Oasis suite, a private pay option, for seniors needing transitional care. If short-term rehabilitation or long-term health services are needed, Ridge Crest offers quality skilled nursing care. Learn more by calling 1-866-761-8510 or filling out the form below.