Stroke Rehab Facilities and Settings

Perhaps you’ve already figured out where you are, and where you’re going in this healthcare circus.  But if not, here are a few basic definitions:

Acute-Care Hospital

After a stroke, a patient is first admitted to the hospital (most likely through the emergency department).  This is called an acute-care facility.  (Acute meaning of recent onset)  After the patient has been stabilized, and the physician’s have determined that there is no immediate threat of death or other serious health complications, the patient is transferred to an inpatient rehab facility.

Inpatient Rehab Facility

This could be simply a different floor in the same hospital, or it might be a completely different facility to which the patient is transferred.  Stroke survivors will typically stay 2-3 weeks in an inpatient rehab facility.  Intensive therapy is performed here, which includes physical, occupational, and speech therapy.  Generally 3 hours per day, 5-6 days per week.  From here, a patient’s next stop depends on several factors.  Those who still have not regained enough function to perform basic self-care and daily activities, and lack sufficient help from loved ones, will likely be transferred to a skilled nursing facility (nursing home).  Some will return to their homes and receive homehealth services.  And still others will return home and attend rehab sessions at an outpatient therapy clinic.

Skilled Nursing Facility or Nursing Home

There are varying levels of rehab services provided in nursing facilities.  In general, a skilled nursing facility will have a greater emphasis on rehab, than a traditional nursing home, which will emphasize caring for daily needs.  Medicare usually sets the pace for all other forms of insurance coverage, and it will only cover a nursing facility if rehab services are included in the care.  Of course, after a stroke, this is what will be needed anyway.  However, the rehab services provided in skilled and traditional nursing facilities are usually less extensive and intense than the rehab services of inpatient rehab facilties.  Also, keep in mind that Medicare will only pay for 100 consecutive days in a nursing facility (actually they pay 100% for the first 20 days, and then you will be required to pay a co-pay amount for each of days 21 through 100).

Homehealth Services

Some who return home are eligible for nursing, physical, occupational, speech, and/or psychological therapy in their homes.  The person must be of home-bound status, meaning that they have physical, cognitive, or psychological deficits that make it too difficult for them to leave their home and attend therapy sessions at an outpatient clinic.  This provides the patient with valuable rehab services, but of course there will be no access to large therapy equipment in the home (like body-weight supported treadmills).  The advantage, of course, is that you don’t have to expend all of your energy getting to and from your rehab services.  This could be a huge benefit, allowing you to focus all of your energy on actual rehab efforts.  But it could also be detrimental, if your home therapy providers are not willing to spend a lot of quality time with you on each visit (Unfortunately, some are motivated to see a lot of patients each day, which means shorter treatment sessions for YOU!  If you’re not happy with your home PT, OT, or SLP, don’t be afraid to contact the company and voice your complaints.)

Outpatient Therapy

This is for the stroke survivor who has made it home, and is physically and cognitively capable of getting to and from an outpatient clinic (outpatient means that the patient does not stay IN the facility overnight, as they do in an INpatient facility).  There are outpatient therapy clinics which provide one or more of the following:  physical therapy, occupational therapy, and speech therapy.  (see Stroke Rehab Professionals for descriptions of these types of therapy)

Outpatient clinics that specialize in neurological rehab would be more appropriate after a stroke than orthopedic, manual, or sports therapy clinics.  If you’re not sure, ask the clinic what types of diagnosis they typically treat.

Therapy three times per week, for an hour to an hour and a half is typical.  But there are some clinics that will provide more extensive treatment.

Aquatic Therapy

Some inpatient and outpatient rehab facilities are equipped with therapy pools.  It is often easier to stand and walk in a pool, than it is on land, after a stroke.  The bouyancy of the water allows the stroke survivor to perform many exercises that he/she would not be able to perform on land.  This is great for general exercise/conditioning, and for beginning to activate some muscles that have been paretic (weak due to neurological injury).  However, some question the ability of working on specific movements in the pool to carry-over into “real life” movements.  In other words, most of us don’t live in the water.  So the forces that we experience in the water are very different from the force of gravity that we experience on land.  That’s something to ask your therapist about.