Knowing where to turn for rehabilitation and support after a stroke can be overwhelming, according to expert volunteers from the American Stroke Association, which published its first-ever Guidelines for Stroke Rehabilitation and Recovery for Adults.
“There is increasing evidence that rehabilitation can have a big impact on survivors’ quality of life, so the time is right to review the evidence in this complex field and highlight effective and important aspects of rehabilitation,” said Carolee J. Winstein, Ph.D., lead author of the scientific statement published in the May 2016 issue of the American Heart Association journal Stroke.
Stroke rehabilitation often requires healthcare professionals from several disciplines because a stroke can affect many functions: paralysis and weakness; gross and fine motor skills; speech and language; cognition; vision; and emotions. Yet limited timeframes to find care after discharge can be challenging. The average hospital stay in acute care is between four (ischemic) and seven days (hemorrhagic stroke). Most stroke patients are transferred from acute care to an inpatient rehabilitation facility (IRF); a skilled nursing facility (SNF) or a long-term acute care (LTAC) hospital. Those discharged to home may have home health, outpatient therapy, or hospice care.
Rehab dollars should be used wisely, and at an inpatient rehabilitation facility if possible, Winstein said. Families should first check with their insurance plan to see what types of post-acute care are covered. Evaluating inpatient rehabilitation facilities and skilled nursing facilities? Here’s a short breakdown of the services both provide, and questions to ask:
Inpatient rehab facilities typically take a team approach, with therapists meeting to discuss patient care. The patient must be able to participate in three hours of therapy every day. Medicare will cover up to 90 days in an inpatient rehab facility (or longer in some instances, although cost sharing is very high). Medicare.gov is launching a public quality rating program for IRFs this fall.
If a patient can’t participate in three hours of daily therapy, a skilled nursing facility with a coordinated rehab program may be able to provide care, but resources, facility and programs provided vary, and finding the right place may require some investigation. Medicare will usually cover up to 100 days. Medicare.gov posts public quality ratings for skilled nursing facilities, a good way to evaluate facilities apples-to-apples with specific quality measures.
(Also see “Commission on Accreditation of Rehabilitation Facilities.”)
Patients discharged from the hospital directly home may receive rehabilitation services from a home health agency or on an outpatient basis. Medicare covers up to 60 days of home health services. Insurance limits on outpatient therapy services can be as short as 2-3 weeks for physical, occupational and speech therapy, but Medicare has an “exceptions process” that allows patients to receive additional outpatient therapy if medically necessary.
Questions, questions, questions: Ask the right ones!
The patient and family both need to be involved when choosing a facility. Start with these questions:
What types of rehab care will my insurance cover?
Do you have a stroke rehab program, and if so, how many patients are in it?
How do you assure high-quality care?
What do you look for in terms of progress, and how often do you evaluate it?
What percentage of your short-term residents are successfully discharged home?
Where does rehab occur? What therapy programs are available?
How do you prepare the patient and caregiver for home?
How do you help caregivers?
What is done to help prevent falls?
Questions to ask your doctor before your loved one is discharged:
What is the extent of my loved one’s stroke damage? What areas of the brain have been affected?
What is the prognosis and expected course for recovery?
What types of services are likely to improve the outcome?
Does this depend on the areas of the brain where the stroke caused damage?
What is my loved one’s ability to participate and engage in various post-acute services?
What is my/my loved one’s underlying medical/health situation and complexity, and what other medical services will be required?
Questions to ask about or directly to the post-acute setting(s):
Is the rehab facility certified to care for people with a stroke?
What is the maximum amount of rehabilitation services my loved one can receive?
How intense will it be?
What medical services are available?
What special clinical training do the nurses, social workers and dieticians have?
How does the setting measure functional recovery, and what outcomes are typical for stroke patients?
Another important resource is the Commission on the Accreditation of Rehabilitation Facilities, which has been accrediting IRFs and outpatient rehab programs for 50 years. Accredited hospitals are evaluated based on standard criteria and guidelines that provide the best outcomes. Listings of accredited providers are easily searchable. They also accredit stroke rehabilitation programs in some skilled nursing facilities with stroke specialty accreditation.