Posted on March 12, 2021 by Elder Care Consultants, Inc.

Post Hospital Rehabilitation

Following a hospital stay for a planned surgery, an injury or illness, many patients benefit from skilled rehabilitation at a facility after discharge. There are two types of facilities: (1) Inpatient Acute Rehabilitation Facility (IRF); and (2) Sub-Acute Rehabilitation Facility (SNF). Note: SNF refers more generally to a Skilled Nursing Facility, which many people know as a “Long-term Care / Nursing Home.” Many Sub-Acute rehab rooms are located within a SNF.

Both facilities provide physical therapy (PT), occupational therapy (OT), speech therapy (ST), therapeutic recreation (RT), and nursing. Below are some differences.

Intensity:

IRF patients must be able to participate in two three-hour intensive therapy sessions, five to six days a week. Typically, the goal is to return patients to the community quickly with an average stay of 12-15 days.
IRF treatment teams maintain a vigorous approach toward functional improvement and update the patient’s treatment plan weekly.
SNF patients may receive therapy from four to six days a week, but for shorter sessions than at an IRF, one to two hours per day. The average length of stay is 26.4 days. The goal may be to return home, to an independent or assisted living facility, or to a long-term care facility.
SNF treatment teams update their treatment plan at least every 30 days while the patient is receiving skilled (rehab) care.

Staffing:

IRF’s must have a board-certified rehabilitation physician and a physiatrist on staff. The physician must see the patient at least three times a week and often has an office on-site.
IRF’s often have Certified Rehabilitation Registered Nurses (CRRN).
SNF physicians must see the patient every 30 days while the patient is receiving skilled care and their office is typically located off-site.

Payment:

Medicare Part A (or other insurance policies) covers the cost of both IRF and SNF skilled care so long as the patient continues to meet the insurance guidelines (www.medicare.gov).

IRF costs are covered fully for a maximum of 60 days. If the stay exceeds 60 days, the patient is charged a co-pay for days 61-90 or may use their Medicare Lifetime Reserve Days.
SNF rehab stays are covered for days 1-20. Days 21-100 have a co-pay which may be covered (all or part) by the patient’s supplemental plan. Medicare advantage plans may be different.

Who decides which type of facility is best? If the patient meets Medicare’s rehabilitation benefit guidelines for care at a facility, the decision about which kind of facility is made by the hospital treatment team in coordination with the receiving facility. However, the patient, family, or care manager can offer important input:

If the patient’s endurance was good prior to hospitalization it may be appropriate to advocate for a trial stay at an IRF, even if the patient may not be able to return home, but perhaps instead to an assisted living facility.
If there is no IRF nearby, the family may decide that rehabilitation at a SNF should be considered. While at the SNF, family members or a care manager can advocate for more therapy and more frequent treatment plan reviews.
If a patient’s level of functioning is low, then a SNF may initially be more appropriate. If the patient makes significant gains while at the SNF, then a referral and possible transfer to an IRF for more intensive therapy can be considered.