Rehabilitation should begin as soon as the patient stabilizes. Generally, this first stage of rehabilitation occurs in the hospital. In planning for discharge from the hospital, the patient and their family, with the support of the social workers or case manager, must determine the best place for the patient’s care. Many patients return home, but others benefit from time in a rehabilitation program to continue recovery.
In-Patient Rehabilitation Facilities
Inpatient rehabilitation may be located independently or may be part of a large hospital complex. Patients usually remain in the facility for two or three weeks and participate in an intensive, coordinated rehabilitation program. These programs often include at least three hours per day of active therapy, five or six days a week. Inpatient facilities offer a full suite of medical services, including 24-hour doctor supervision and access to a full range of therapists specializing in rehabilitation after a stroke.
Skilled Nursing Facilities (SNFs)
The rehabilitation services available in SNFs are for patients no longer needing hospital care but who still require some nursing services and a less intensive rehabilitation program with fewer hours of required therapy participation.
These are long-term care facilities for those patients no longer needing full hospital care but who still require 24-hour access to nursing support. Rehabilitation services may be offered to individuals in these facilities as they qualify.
Home and Out-Patient Rehabilitation Programs
From home, patients may travel to a rehabilitation facility or clinic, which may be stand alone or be connected to a hospital complex. Participating in a facility offers access to a wide range of regimen and therapist. Rehabilitation can also be provided in the home. These arrangements are usually the most convenient for people who don’t have transportation or who require treatment from a single type of rehabilitation therapist. Patients who depend on the Medicare program for rehabilitation must meet Medicare's requirements to be "homebound" to qualify for these services. For now, lack of transportation is not a valid reason to receive home therapy. The biggest disadvantage of home rehabilitation is the lack of specialized equipment. However, performing treatment at home gives people the advantage of practicing skills and developing compensation strategies within their own environment.
You and your family 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? How do you evaluate progress?
What percentage of your short-term residents are successfully discharged home?
Where does rehab occur? What therapy programs are available?
How do you prepare me to return 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?