Monday, January 1, 2018

Tell Me About Rehab

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Retreat & Refresh Stroke Camp

a division of United Stroke Alliance

www.unitedstrokealliance.org


The following was first posted on the American Stroke Association's StrokeConnection website: 

http://strokeconnection.strokeassociation.org


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WHAT WILL I DO IN REHAB? 


What you do in rehab depends on what you need to be independent. 

Areas you may need to improve include: 

  • Self-care skills such as feeding, grooming, bathing, toileting and dressing,
  • Mobility skills such as transferring (from chair to bed or bed to chair, etc), walking or self-propelling a wheelchair, 
  • Communication skills in speech and language, 
  • Cognitive skills such as memory or problem solving, 
  • Social skills for interacting with other people. 

WHEN DOES REHAB BEGIN? 
Your doctor decides when you’re stable and able to benefit from it. Most rehab services require a doctor's order. 

WHAT IS A REHAB PROGRAM? 
A program may include: 
• Rehabilitation Nursing 
• Physical Therapy 
• Occupational Therapy 
• Speech-Language Pathology 
• Audiology 
• Recreational Therapy 
• Nutritional Care 
• Counseling 
• Social Work 
• Psychiatry/Psychology 
• Chaplaincy 
• Patient/Family Education 
• Support Groups

STROKE REHAB SHOULD INCLUDE: 
• Training to improve mobility and ability to do daily tasks 
• Tailored post-stroke exercise program 
• Access to cognitive/engagement activities (books, games, computer) 
• Speech therapy, if stroke caused difficulty speaking or swallowing 
• Eye exercises, if stroke caused a loss of vision 
• Balance training for those with poor balance or with a fall risk 
• Adaptive strategies to help you function within a “new normal”

CHOOSING THE RIGHT SETTING

YOU CAN REHAB AT: 

• Inpatient Rehabilitation Facilities 
• Skilled Nursing Facilities 
• Home (through Home Health Agencies) 
• Outpatient Care Your needs determine which type(s) is best for you. 

INPATIENT REHABILITATION FACILITY (IRF) 

An IRF can be a separate unit of a hospital or a free-standing building that provides hospital-level care to stroke survivors who need intensive rehabilitation. IRFs provide at least three hours a day of active rehabilitation at least five days a week with: 

• Physical Therapists 
• Occupational Therapists 
• Speech Therapists 
• Nurses (available 24/7) 
• Doctors typically visit daily 

The AHA/ASA recommends IRF care if you can tolerate at least three hours a day of stroke rehabilitation. Medicare generally covers your care in an IRF. You will need to pay your Medicare Part A deductible and coinsurance. Some Medicare supplemental (“Medigap”) insurance policies will cover part or all of your deductible and coinsurance so check your insurance coverage. Private insurance coverage for IRF care varies. 

SKILLED NURSING FACILITY (SNF) 

A SNF provides rehabilitation care and skilled nursing services for patients who: 

• Are not well enough to be discharged to home and cannot tolerate the more intensive amount of therapy provided by an IRF. 
• Can benefit from having a a registered nurse on site for a minimum of eight hours a day (on a physician’s plan). Need nursing and/or rehabilitation. 
• Don’t need daily supervision by a physician, although the care provided must still be based on a physician’s plans. 

A SNF can be a standalone facility, but when it is in a nursing home or hospital it must be a separately licensed unit, wing or building. Medicare will generally cover up to 100 days in a SNF. You will pay nothing for the first 20 days. There will be a co-pay for days 21-100. Some Medicare supplemental (“Medigap”) insurance policies will cover part or all of your co-pay so check your insurance coverage. Private insurance coverage for care at a SNF varies.


LONG TERM CARE FACILITY 

• Long term care facilities provide long-term basic nursing care and assistance for people who need help with everyday activities, such as dressing or bathing. This is residential care for people who can’t live in the community.

• Long term care facilities provide limited rehabilitative services except for those receiving care through a separate SNF wing or unit.

• Long-term care is generally paid out of pocket, by long-term care insurance or through the Medicaid program. Medicare and most private health insurance (comprehensive medical) policies do NOT cover long term care facilitiy care.

LONG-TERM ACUTE CARE HOSPITALS 

• Provide extended care to those with complex medical needs (such as those on a ventilator) due to a combination of acute and chronic conditions.

• The average length of stay is 25+ days.

• Medicare, Medicaid and most private health insurance plans cover this care, although you may have copays or coinsurance.

HOME OR OUTPATIENT 

• Provided by home healthcare agencies or in outpatient office. 

• Medicare, Medicaid and some private insurance plans cover home health care. Medicare and many private insurance companies impose caps on the number of outpatient therapy sessions they will cover. Medicare has an “exceptions process” that will allow you to get additional sessions if they are medically necessary.
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Next week I will post a list of question to ask health care providers when seeking rehab facilities.
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