Q: My friend was recently in the hospital after having a fall and hurting her knee. The hospital told her that she would need some type of rehab and explained that she would be evaluated for options. My friend is adamant that she wants to rehab at home. What are her options?
A: Many times after an injury, especially one requiring hospitalization, rehabilitation is recommended. The type of rehab needed depends on the type of injury. Your friend may need one therapy or a combination of therapies. The goal is to restore or improve function. A few of the common categories of rehab include:
Physical Therapy: A focus on strength training, balance, flexibility, coordination and gait training. The goal is to rebuild strength and promote safety to enable a person to return to a normal activity level.
Occupational Therapy: A focus involved on daily living tasks, such as grooming, dressing, bathing, shaving, cooking, driving and other adaptations that may be needed in the environment to help a person function at the highest possible level.
Speech Therapy: A focus on weakness or deficit with the oral muscles, mouth or throat. Issues can impact speech and swallowing functionality. Treatments focus on evaluating communication, safety mechanisms and appropriate diet to address concerns.
Other forms of rehab may include balance therapy, respiratory therapy, neuropsychology or vision therapy.
Typically, the doctor or a social service professional orders an evaluation, discusses the recommendations and makes a referral to the provider. Therapy services are typically reimbursed through insurance, but not always. This may depend on the initial order, the outcome of the evaluation, continued progress, and what insurance a person has and where the services are received. For example, for inpatient therapy, a three-night hospital stay is usually required. Therapy or rehab services may start while a person is still in the hospital. Upon discharge, continued rehabilitation may occur in a variety of settings.
Inpatient Rehabilitation follows hospitalization. This could be a hospital-based rehab, a free-standing rehab inpatient center or part of a skilled-nursing facility. This is necessary if a person is not able to return to his or her previous environment safely. The first 20 days are covered by a traditional Medicare Part A program, and there is a co-pay for the remaining 80 days, if qualified. Supplemental insurance would normally cover inpatient services.
Outpatient Rehabilitation takes place when a person is able to safely be on his or her own but still requires services to restore or improve function. Therapy may be at an outpatient clinic or in the home. Traditional Medicare Part B provides for a set amount of funds per year for outpatient services. As a primary insurance, it would cover 80 percent of the cost, and the supplemental policy would cover the additional 20 percent. If assistance is needed with daily living at home, private-duty caregivers would be an out-of-pocket cost.
Length of hospital stay and insurance requirements for reimbursement are fairly specific. If she is in a managed care plan or other non-traditional plan, your friend should find out how rehab services are reimbursed. This is where the hospital staff can assist in educating your friend on options based on the specific orders and pay source.
While many people would probably prefer an in home care setting, a rehab center may be necessary. The right provider may depend on location, specialty and availability. Encourage your friend to ask questions and discuss preferences. You can also help be an advocate for her by keeping notes of discussions, as it is often a lot of information to take in.
Readers may send questions to Amy Natt, an Aging Life CareTM Professional, certified senior advisor and CEO of Aging Outreach Services. She can be reached at firstname.lastname@example.org.