Family Caregiver Guide
PrintWhat Is Rehab?
Your family member may have been referred to rehab after being in a hospital due to acute (current) illness, injury, or surgery. Rehabilitation (or simply “rehab”) is treatment to help patients regain (get back) all or some of the movement and function lost because of current health problem.
Rehab is very different from hospital care and can be very confusing for you and your family member. While your family member might still be quite ill and need medical attention, he or she will be expected to be active during the rehab process.
You will find that things are done differently in rehab than in a hospital. You will see many active patients and therapists in the halls and treatment rooms. In general, you will find rehab a positive “workout” atmosphere rather than a place for sick people.
Your family member will be expected to work as hard as possible during the rehab process, and you will have many responsibilities. For example, you will be expected to provide loose, comfortable clothing for your family member to make it easy for him or her to get dressed and to take part in treatment sessions. You will be expected to participate in meetings with the medical team.
Many patients and family members say this is a very confusing transition (move), especially since you may be coming directly from a hospital. This guide will give you some basic information to get you started and to help you and your family member understand the process.
Here are five important points to remember:
- The goal of rehab is to help patients be independent — doing as much for themselves as they can.
- Rehab is done with a patient, not to a patient. Your family member must be willing and able to work with rehab services during active treatment and, later, with caregivers or by themselves at home.
- The patient’s chronic (long-term) health conditions, such as high blood pressure or cholesterol, are treated during rehab, but they are not the reason the patient is in rehab.
- Most rehab services last weeks, not months.
- Most insurance policies cover rehab when ordered by a doctor, but there will probably be extra costs.
Rehab Services
Patients often work with two or more rehab services. These include:
- Physical therapy (PT). This helps patients with problems moving, balancing, walking, and performing other activities. PT can also help patients with prosthetic (artificial) arms or legs, shoe inserts, wheelchairs, walkers, and other assistive devices.
- Occupational therapy (OT). This helps patients be more independent with self-care and other daily tasks, such as eating, getting dressed, typing, and using the telephone.
- Speech therapy. This helps patients relearn language skills such as talking, reading, and writing. It can also help with swallowing problems.
- Psychological counseling (or simply “counseling”). This helps patients (and sometimes also their family members) adjust to major life changes caused by an illness or injury. Counseling may be offered individually (one patient at a time) or in a group.
Going from Hospital to Inpatient Rehab to Home
- Going from hospital to rehab. Hospital staff will tell the rehab facility about what they did as treatment and care for your family member.
- Clothing. Your family member will need to wear comfortable clothes (not gowns) to participate in therapy sessions (such as physical therapy or occupational therapy). The facility does not provide such clothing, so you will have to bring them from home or buy them. It is important to put labels in the clothing and bring them to the rehab facility at time of admission. Make sure to ask the rehab team how to label your family member’s clothes, and about the facility’s specific policies about clothing.
- Initial assessment for restorative potential. Rehab staff will assess your family member within 2 days of admission. The most important finding is “restorative potential.” This means the level of function (ability to move or do activities) that your family member is likely to regain from rehab. Restorative potential has to do only with the current illness, and not any chronic condition, such as diabetes, arthritis, or dementia. Insurance pays for rehab only when your family member is making progress toward restorative potential.
- Rehab begins. The amount of time your family member spends in rehab depends on the type of facility. Staff will assess your family member throughout the rehab process to make sure he or she is making progress toward restorative potential.
- Care plan (“team”) meeting. This meeting takes place after rehab has started. It includes staff from nursing, social service, dietary, recreation, and rehabilitation who discuss your family member’s progress. You and your family member will be asked to attend. This is a good time to ask questions and raise any concerns.
- Discharge to home. Patients are discharged from rehab when the team assesses that they have reached a plateau (a time when the patient is not making any progress, but is not getting any worse). This means that the patient is not likely to make more progress. When your family member reaches a plateau, rehab staff will give you a written notice stating that Medicare or other insurance will end on a certain date (often the day after this notice is given). Speak up and let the staff know if you feel that your family member needs more time.
- When your family member cannot go home.
Although your goal may be to have your family member discharged to home, this is not always possible. Some patients move to the regular long-term care part of a SNF because they can no longer manage at home. You should be aware of this possibility. This kind of transition requires planning and careful consideration of your family member’s needs and your own situation. Talk to the social worker about any concerns and questions you have regarding this transition.
- Rehab after discharge. Many patients continue their rehab after leaving an inpatient setting. This can happen at home or in the community as an outpatient. Many patients feel much better and improve quickly when they have returned to the comforts of home.
Factors that Affect a Patient’s Rehab Progress
To repeat, rehab is hard work. Here are some factors that can affect a patient’s progress:
- Patient motivation (how much a patient is willing to work at rehab). People differ when it comes to motivation. It can depend on a person’s illness, type of rehab, and restorative potential. A person’s personality is also a factor; some people like a challenge while others do better without pressure. Sometimes it is hard to know whether to respond with a gentle or a firm approach. Praise is always good, even if progress seems slow. Family caregivers can help by talking with rehab staff about how their family member has dealt with other life challenges.
- Relationships with therapists. Your family member will likely work with many therapists. Of course, each has his or her own style. Let each therapist know what style works best, and ask that this information be written in the treatment plan.
- Expectations. One of the hardest parts of rehab is being realistic about how much function a patient can get back. Some patients make a full recovery and get back to the same level as before. Other patients improve just a little. You and your family member may need to adjust expectations and learn new ways of doing daily tasks.
- Feelings. Patients can have a wide range of feelings during rehab. These feelings can be about the injury or illness itself, attitudes about rehab and restorative potential, or expectations for recovery. Feeling tired, angry, discouraged, or overwhelmed is normal and part of the rehab process. Talk with the staff if you think these feelings are so strong that they may affect rehab progress. As a family caregiver who is watching or being part of the rehab process, you will also have many strong feelings. You may need someone to talk to as well. It may help to discuss these feelings with the social worker, or ask the staff who can help you.
How Family Caregivers Can Help
- Have a good relationship with rehab staff. Talk with staff about the rehab plan. Ask how your family member is doing in treatment. Speak up if you have concerns about the care your family member is getting.
- Encourage independence. The purpose of rehab is to help patients be as independent as possible. You can help by encouraging your family member to do as much as he or she can. This is a sign of caring, not disrespect. It does not help to be overprotective, which can slow a patient’s progress.
- Balance your need to know with your family member’s wish for privacy. While some patients always want caregivers with them, others prefer to have treatments alone. Talk with your family member about the right balance between these options.
- Figure out when and how much to visit. While of course you want to help your family member, you likely have other work or family responsibilities. Even if you can visit only in the evening, you can still talk with night staff or make an appointment to meet with staff another time.
- Find ways to help. This can be friendly visits, bringing pictures from home, going to care plan meetings, talking with staff about discharge, going to rehab sessions, or working with the therapists.
Paying for Rehab Services
Insurance coverage can be confusing. Your family member may have Medicaid, Medicare, private health insurance, or some combination of these plans. Make sure you fully understand what insurance will and will not pay for. We strongly suggest that you learn more by talking with the financial office at your family member’s rehab facility.
Here are some basic facts about paying for rehab:
Medicaid. Medicaid will pay for rehab if your family member meets its strict guidelines about the type and amount of service. If your family member is eligible for Medicaid but does not yet have it, staff at the rehab setting can help you apply.
Medicare. Medicare may or may not pay for rehab services from a skilled nursing facility (SNF). To qualify, your family member must:
- Need skilled nursing care 7 days a week or skilled rehab services 5 days a week. A doctor or nurse practitioner must certify that your family member needs these services.
- Have been in a hospital for at least 3 consecutive days (not counting the discharge day) within the 30-day period before going to a SNF.
- Be admitted to the SNF for the same illness or injury that was treated in the hospital.
- Be assessed by rehab staff at least once a week to find out whether he or she has reached restorative potential. Medicare stops paying for rehab services when patients reach this level.
Medicare uses the term “benefit period” to define the time for rehab services. Here are some facts:
- A benefit period begins on the first day your family member is admitted to a hospital or a SNF and continues for up to 100 days. It ends when your family member has not received services from a hospital or SNF for 60 days in a row.
- Medicare will assess staff reports of your family member’s progress and stop paying for rehab services when he or she has reached restorative potential. This may take less than 100 days.
- You can appeal if Medicare says that it will no longer pay for rehab services. Understand that there is a lot of paperwork involved. To learn more about how to appeal a Medicare decision, talk with the people at the financial office at the rehab facility.
- Medicare puts no limits on the number of benefit periods a patient can have.
- When Medicare pays for rehab services, it pays the full cost for the first 20 days and part of the cost for the next 80. Your family member or you will have to pay a co-insurance cost during these 80 days. This fee is set by Medicare and not the rehab setting.
Medicare and Medicaid. Some patients are “dually eligible”; this means they have Medicaid and Medicare at the same time. When this happens, Medicaid pays for rehab services not covered by Medicare.
Private health insurance. Most health insurance plans follow the same guidelines as Medicare, but may require more frequent assessments of the patient’s restorative potential. Talk with the health insurance company when your family member is admitted to rehab and throughout the course of care.
Other Costs
Even when Medicare or other insurance pays for all or most of rehab, there may still be costs that you or your family member has to pay. They may include:
- Private telephones, haircuts, and other personal care services.
- Ambulance transportation. While Medicare or other insurance will pay for an ambulance to take your family member from the hospital to an inpatient rehab facility, it may not pay the costs of going elsewhere for other tests.
- Service after a patient reaches restorative potential. Some patients need more time to reach their full potential. If Medicare or other health insurance has ended, your family member may have to move to another setting. Staff will assess your family member to get a better idea of what services he or she needs. You or your family member must pay all costs that insurance does not cover. This situation is quite common, especially with older adults. The good news is that your family member is still making progress toward rehab goals.
©2013 United Hospital Fund