May 29, 2025

Aftercare Right After

Upon leaving the inpatient level of care, if your loved one needs additional care for physical health issues and rehab there are few options if managed care is covering the cost and there are certainly differences between facilities at each level of care.

Skilled Nursing Facilities: These are the regular nursing homes. Many of them provide rehab these days and when your loved one requires two to three people assisting them, as Mom did for a time, and is only up to participating in PT and OT a little each day, they will meet criteria for this level of care. The good news is that with Medicare Part A a stay in a Skilled Nursing facility comes out of a separate “bucket” of days than the inpatient hospital days so they do not run out as quickly (more on this later). Even more good news is that some skilled nursing facilities have rehab hallways where those who are there for a temporary stay can live temporarily and, dare I say, sometimes things seem a little nicer there.

Intensive Rehab Facilities: I was always ready to beg to get Mom into these facilities as they are the super nice, shiny, multidisciplinary treatment team guided superstar places to go for rehab after being in the hospital. They have fully equipped gyms and many highly trained professionals ready to get a person back in tip top shape. The good news is that when a patient has to go to a skilled nursing facility first to become strong enough to hang with 3 hours a day (split up) of PT and OT, the patient can, when ready, graduate up to admission to one of these facilities. More good news is that they work with patients as much as they can through their tougher days and often PT and OT can be all about ADLs, basic at home tasks, and walking if that is what your loved one needs. The bad news is that these facilities count to Medicare as just like being in the inpatient hospital. Your loved one will continue to use up their inpatient hospital day allowance from Medicare by being here. This I found very confusing because it’s a more intensive program than skilled nursing and people have to be more able-bodied to go there and when they are sicker and need more support they have to go to skilled nursing. Mom had burned through tons of days before I was informed that this level of care counts the same as being in the regular hospital.

Specialty Hospitals: Mom entered one of these facilities, equipped to handle medically complex cases and mechanical devices, following a surgeon’s error that put her on a wound vac. This level of care is very much a hospital with low-functioning patients. Mom was able to get PT and OT at this facility and excellent care of the wound vac, but again we burned through inpatient hospital days from her Medicare allowance quickly having her there. It was the best available choice at the time as the small hospital’s caseworker was shoving us out the door offering open beds at two 1 star skilled nursing facilities and a 3 star skilled nursing facility which was an hour away. We quickly seized the bed at the specialty hospital for which Mom only qualified because of the wound vac and sadly were thankful that we were not worrying about her during a 1-star nursing home stay.

Home Health: If your loved one can come home directly from the hospital but needs ongoing support and has a great deal of difficulty getting out to outpatient appointments, home health will come to your home. You get a nurse a couple of times a week, sometimes PT and OT if ordered, and sometimes a social worker and others with physician orders. Depending on the agency sometimes visits are inconsistent and unfortunately the staff has to work more around their schedule than yours because of driving around to multiple patients. After Dad’s heart attack and quadruple bypass a few years ago I was very thankful for home health’s visits, especially because his home health treatment team came with a nursing assistant who helped him with the first few at home showers for which I am grateful. The home health team we have had a few rounds with now did not have a nursing assistant on staff. Be aware that having home health rotate through involves some brief check-ins and short sessions of support. This will not substitute for support for your loved one with meals, laundry, help in and out of the shower or while dressing, and any other day to day or overnight care needed. If you hope for your loved one to live at home and that is what they want also, have the conversation early and often about who will step in and do what to provide support or even care, to take your loved one to appointments, and to coordinate care and advocate as needed.