Inpatient Rehabilitation Facilities

Inpatient Rehabilitation Facilities provide intensive rehabilitation services to patients with complex conditions such as stroke or brain injuries.

Inpatient rehabilitation facilities, also referred to as rehabilitation hospitals, specialize in the rehabilitation of patients with complex medical needs who require intensive daily therapy to help regain independence and return home or to the next setting of care. They can be freestanding facilities or specialized units within hospitals.

To qualify as an IRF, a facility must meet Medicare’s conditions of participation for acute care hospitals and must be primarily focused on treating conditions that typically require intensive rehabilitation, greater than the level of care that can be provided at a skilled nursing facility, among other requirements.

Blog Post: What is an Inpatient Rehabilitation Facility?

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What types of services are offered in an Inpatient Rehabilitation Facility?

Programs at these facilities are managed by rehabilitation physicians and therapists that specialize in services such as physical and occupational therapy, rehabilitation nursing, speech–language pathology, as well as prosthetic and orthotic devices.

Common types of patient conditions treated at inpatient rehabilitation facilities include:

• Stroke rehabilitation
• Joint replacement (orthopedics) or amputations
• Head trauma (brain injury, disease or condition)
• Spinal cord injury or disease

The sophisticated level of care provided at an inpatient rehabilitation facility is typically unavailable in other settings, such as skilled nursing facilities or nursing homes. Inpatient rehabs offer hospital-level care and intensive rehabilitation after an illness, injury, or surgery. Rehabilitation is provided as part of a care plan that’s developed and overseen by a specialty physician.

Patients looking to receive care through an inpatient rehabilitation facility must first have a doctor diagnose them with a condition that requires 24 hour access to a doctor and rehabilitation nurse and frequent in-person sessions with a rehabilitation physician. Patients in inpatient rehabilitation facilities must be able to complete three hours of intense rehabilitation each day for five days a week and be able to progress towards functional goals within a reasonable period of time.

Common services provided through inpatient rehabilitation include:

• Physical rehabilitation
• Occupational rehabilitation
• Skilled nursing
• Speech/language pathology
• Prosthetic gait training and limb management

Learn More: What Services Are Offered in an Inpatient Rehab Facility?

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Inpatient Rehabilitation Facilities vs. Skilled Nursing Facilities

In general, inpatient rehabilitation facilities are focused on treating conditions that typically require intensive rehabilitation and a more sophisticated level of care than is available in other settings outside of a hospital, including skilled nursing facilities, nursing homes, assisted living centers or extended care centers. The table below highlights some key differences between care at an inpatient rehabilitation facility and care at a skilled nursing facility.

	Inpatient Rehabilitation Facility	Skilled Nursing Facility
Physician Visits	Daily	2-3 times a week
Level of Care	Complex	Basic support
Therapy Duration	3-5 hours a day (intensive)	1-2 hours a day (non-intensive)
Average Length of Stay	2-3 weeks	3-6 weeks
Care Coordination	Multidisciplinary care team led by a physician to determine individualized treatment approaches	Individual attending physician leading a team of nurses within the same discipline

Learn More About Skilled Nursing Facilities

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How to choose an Inpatient Rehabilitation Facility?

There are four main steps to selecting an inpatient rehabilitation facility:

1) Understand Your Medical Needs

Meet with a medical professional to make sure that an inpatient rehabilitation facility is the best follow up care option for you or your loved one. An inpatient rehabilitation facility is the best fit for patients with complex medical conditions who require intense medical rehabilitation. If the patient does not have a complex condition or requires only basic rehabilitative support, a skilled nursing facility may be more appropriate. If the patient does not have any significant medical needs and instead can receive rehabilitation care in the home setting, home health care may be more appropriate. If the patient has a specific medical need (diabetes, chronic disease, wound care, etc.), you can narrow down your search by evaluating facilities based on what specialty care they can provide.

2) Verify Your Insurance Coverage

When selecting an inpatient rehabilitation facility, it’s important to consider your payment options and understand what your insurance policy will and will not cover. If your physician determines that care at an inpatient rehabilitation facility is medically required, most insurance policies, including Medicare, Medicaid and private insurers, will cover at least a component of your stay. For example, if you qualify for Medicare-covered care, your out-of-pocket costs will be similar to an inpatient hospital stay. Remember that each policy is different and it’s important to verify your coverage before making care arrangements. repisodic.com allows you to contact providers to verify whether or not they accept your insurance.

3) Compare Facilities Based on Quality Measures

Quality measures are strong indicators of the quality and level of care and rehabilitation you will receive at a facility. Different qualities to compare are how many of the residents at a given facility showed marked improvements during their stay, how many were re-hospitalized, how many had a fall that resulted in a major injury, and how many were successfully discharged. repisodic provides these metrics, and more, for each facility and measures them against state and national averages to help put them in context and make the comparison process easier for you.

4) Visit the Locations (if possible)

If possible, it’s also helpful to visit the location. You can evaluate cleanliness and entertainment options and talk to employees and current residents about their experience. Ask the staff members how different situations are handled and how you or your loved one will fit in at this location. If you’re unable to visit the location, many repisodic profiles have pictures and video tours to help you make an informed decision.

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Checklist of Things to Consider

Medicare.gov has a list of suggested things to consider when selecting residential rehabilitation facilities:

Basic Information

• Is the facility Medicare/Medicaid certified?
• Does the facility provide necessary skilled care and special services?
• Is there an available bed?
• Are there visiting hours? What are they?
• Are residents clean and appropriately dressed?

Living Spaces

• Are there any unpleasant odors?
• Are the facilities clean and well-kept?
• Are the noise levels appropriate?
• What are the restrictions on smoking?
• Is the facility well furnished?
• Is the temperature comfortable?
• Is there good lighting?

Staff

• Does the staff have good relationships with the residents?
• Do staff members knock on doors before entering?
• Are background checks conducted on staff members?
• Is a full-time registered nurse (RN) available at all times?
• What are the rotations of nurses and staff members working with a given resident?
• Is there a reasonable ratio of staff members to patients?
• Are certified nursing assistants (CNAs) involved with care planning meetings?
• How often is a licensed doctor available?
• How long has the management team worked together?

Residents’ Rooms

• Are residents allowed to have personal belongings?
• Is there personal storage space?
• Do the rooms have adequate windows and natural light?
• Do residents have access to personal phone and television?
• What is the roommate selection process?
• How much protection is available for personal possessions?

Common Spaces

• Are exits are clearly marked?
• Are the visiting areas quiet and well-kept?
• Are there appropriate safety features (emergency evacuation plan, smoke detectors, sprinklers, etc.)?
• Are all areas wheelchair accessible?
• Are there handrails and grab bars in common spaces?

Dining and Activities

• Is there an appropriate variety and choice of foods?
• Are there nutritious snacks?
• Does the facility offer assistance in eating?
• Are a variety of activities offered?
• Are there outdoor areas for residents to use?
• Are there volunteer programs?

Safety and Care

• Does the facility offer preventative care (flu shots, etc.)?
• Are residents allowed to see their regular doctors?
• How does the facility handle emergency situations?
• Are care planning meetings scheduled with residents and family members?
• Has the facility corrected all deficiencies from last state inspection?

If you determine that an inpatient rehabilitation facility is the right choice, the next step is to review facilities in your area and identify those that are covered under your insurance plan. repisodic helps you search and compare facilities by location and provides insightful quality data, patient reviews, and agency ratings to help you find the one that best fit your needs.

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How to Pay for an Inpatient Rehabilitation Facility

Insurance coverage and network participation are two of the most important factors to consider when transitioning to an inpatient rehabilitation facility. Because the services provided are considered medical care, it is covered by health insurance, including Medicare, Medicaid and private insurers. A patient’s individual insurance policy determines what specific rehabilitation services are covered and paid for.

Medicare reimburses stays at an inpatient rehabilitation facility in the same method it does for regular hospital stays. Therefore, you will have the same out-of-pocket costs. Up to the first 60 days of a stay at an IRF, Medicare will cover everything. After that, you will be responsible for a daily copay, which varies depending on the length of stay.

Medicare will cover the following during an inpatient rehabilitation facility stay:

• Semi-private room
• Meals
• Nursing services
• Social worker services
• Medications and medical supplies
• Rehabilitation services, such as occupational, speech or physical therapy

Unlike stays at a skilled nursing facility, a minimum number of days at an acute hospital is not required to enter an inpatient rehabilitation facility. However, you will need to pay the Medicare Part A deductible. If you are transferred from an acute hospital stay, that deductible will apply for the inpatient rehabilitation facility as well.

Coverage under private and commercial insurance plans will be similar to the Medicare policies list above. However please keep in mind that health insurance payment options and programs that cover inpatient rehabilitation facilities are quite complex and regularly subject to change. A patient’s individual insurance policy determines what post-acute care services are covered and paid for. We encourage all patients to consult with their insurance company or administrator for final determination of what post-acute care or rehabilitation services their policy covers.

Blog Post: What Will My Insurance Cover in an Inpatient Rehabilitation Facility?

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