Posted on March 15, 2021 by Elder Care Consultants, Inc.

It can be confusing … but we can help.

While the differences between Inpatient Acute Rehab (IRF) and Sub-Acute Rehab (SNF – Skilled Nursing Facility) seem straight forward, the path from hospitalization to either rehabilitation setting may not be, especially during the pandemic.

Although it may seem to patients and families that discharge from the hospital comes up suddenly, on the hospital side the process actually begins when the patient is admitted. Hospital discharge staff have many patients, facilities, and factors to consider:

Is the patient COVID positive?
Has he/she been vaccinated for COVID?
Does he/she have dementia?
What other conditions does the patient have?
Where do loved ones live?
Which facilities will be accepting new patients at the time of discharge?

A facility that had availability for patients last week may not have availability this week. Discharge staff are working under more pressure than ever, especially during the pandemic to minimize exposure and to free up staff to care for critically ill patients.

Discharge decisions must often be made quickly. The hospital discharge planner will notify the patient and family about a day or so in advance that discharge is scheduled. They will offer some options for the family to investigate depending on whether IRF or SNF is recommended. Even if the patient qualifies for IRF-based rehab, there are far fewer IRF facilities than SNFs, so location will be a significant factor. While there may only be one IRF to consider, there may be several SNF facilities closer to home. Families will be asked to let the discharge planner know which facilities are their top choices.

Prior to COVID, families could quickly arrange to tour and investigate various facilities and let the discharge planner know their top two or three choices. While some facilities are offering limited in-person tours, COVID precautions may require that tours occur virtually, in mock-up rooms, or even that families make decisions based on information on facility websites. The quality of facilities can vary significantly. Additionally, the facility preferred by the family may not have bed availability for the specific discharge day, yet choices must be made quickly.

How are we helping families?

We stay abreast of Medicare and insurance guidelines and changes due to the pandemic.
We work closely with rehab facilities to determine their current rehab status and COVID precautions or restrictions.
We work closely with discharge planners and facilities early in the hospitalization to help ensure that the patient is discharged to the best possible facility.
We quickly get a sense of what facilities may work best for the patient and family.

Our care managers’ experience in the field enables us to provide expert guidance to families. We know the facilities well. We add a breadth of information far beyond what can be gained from a website or even an in-person tour.

Be sure to read Part I on Hospital In-Patient Acute Rehabilitation vs. Sub-Acute Rehabilitation