[ photo by Vladimir Soares]

Options of where to go after acute rehab.

One of the first conversations I have with a patient and their family members is the goal destination after rehabilitation.  In order to determine this it is essential to know their level of functioning prior to the hospitalization.

Was he completely independent, taking care of himself, even driving, before he had that heart attack and bypass surgery? Was her husband helping her out with taking care of her before the stroke? What about the person who had the emergency spine surgery to treat the sudden onset of bilateral lower extremity weakness; was her back pain so bad that she was spending most of her time in her recliner,  just getting by with the occasional stop overs by her children?  

After acute rehab return to prior living place.

The majority of my patients have the goal to return to the same place they were living prior to their hospitalization. That is generally my goal for my patients too. Sometimes, though, this goal is not always achieved. It might be possible to an extent, but often it does not look exactly like it did prior to the hospitalization. When I have that conversation with family members, I talk about the various scenarios that might occur after acute rehab. These possibilities can range from back to home at the previous independent level to not returning home and residing in a nursing home. It is hard to make an accurate prediction so early in the rehabilitation process, though. 

Different paths for different people.

The path after acute rehab might look different than you were expecting as well. In general, we tend to think someone goes to the hospital because they are very sick and once they are better, they go back home. This does happen, but as we age, just a few days in a hospital bed can lead to significant loss of strength and endurance. This then leads to the need for rehabilitation after the acute care hospitalization.

Oftentimes, people think, okay, I will go to acute inpatient rehab and then go home. Well, the trajectory might not be so direct. Some people require a stopover in a long term acute care (LTAC) facility. Being in an LTAC means the patient is stable enough to be discharged from the acute care hospital, but they are still quite sick, requiring a high level of physician and nursing care. From there, the person will likely need more intense rehab. Many patients will be admitted to acute rehab and think this is the final stop before home. Sometimes patients just don’t progress as quickly as is needed to be able to go right to home, so they then go to subacute rehab.

So, as you can see, there are a lot of possible scenarios. I don’t say these things to discourage people or to cause added worry, but rather to help bring understanding that the process is pretty varied. The variety is NORMAL!

Start the planning process early.

You might be wondering why on earth I would be talking about these scenarios so early on. Sometimes patients and/or the families get angry with me, asking how I can be talking about discharge when rehabilitation is just starting. I understand that question, but I have a reason why. I promise. 

The reason I like to start talking about discharge early on is that it is much easier to make arrangements for discharge when you have time to really think about and plan it. It gives family members time to research the various nursing facilities for subacute rehab or to get recommendations for the best home healthcare agencies. I say it is better to have a few different options set up and ready to go early on and then cancel two of the three, rather than have to rush to make one option happen in a couple of days’ time.

When family members are starting to research the various nursing facilities or home healthcare agencies, ask the case manager working on your loved one’s case for a list of recommendations. The case manager generally cannot directly recommend specific places but he or she can at least point you in the right direction. I wrote previously about the process of picking out rehab facilities and nursing homes. Some of the recommendations can also be applied to selecting a home healthcare agency.

Where is the best place to go after acute rehab?

The path after acute rehab looks different from one person to the next. I think it’s better to be prepared for all of the possible scenarios early on so that when the time comes to move your loved one on to the next level of care, you will be able to move into that phase with a little less stress. 

Need help deciding the best place for your loved one after acute rehab? Schedule a consultation with me today and receive a personalized plan of action!

What options for ongoing care are you considering for your aging parent or spouse? Please leave a comment.

© 2020 Jessica Kluetz, DO