Case study · Levels of care

We thought it was rehab. It was a nursing home.

A family story about leaving the hospital, and the questions we now ask before anyone agrees to a place.

What happened

When our founder's grandmother was ready to leave the hospital, the family thought they knew what came next and what it all meant. She was going somewhere to get stronger, and everyone pictured rehab: therapy, then home.

Our founder didn't want her grandmother to go to a nursing home. She believed the family could care for her at home. But when it came to it, they really couldn't.

Only later did it become clear that the place she went was a nursing home, not the rehab the family had pictured. When they finally understood what it meant, our founder started learning everything she could: the different levels of care, what each one covers, and what nobody had explained to them. Many families find out the same way, after the choice has been made, when it is much harder to change.

That experience is a big part of why Rerouted Health exists. Understanding when rehab is right, when a nursing facility is right, and when home is right, and planning ahead in case more therapy is needed, is some of the most important work we do with families.

Why these places are easy to mix up

From the outside, the settings can look alike, and the same building can offer more than one kind of care. What matters is what kind of stay it is, because that decides how much therapy there is, how long it lasts and who pays.

• Inpatient rehabilitation facility. Hospital-level rehab for people who need, and can take part in, intensive therapy: usually about three hours a day, five days a week.
• Skilled nursing facility (short-term). Daily skilled nursing or therapy for a limited time after a hospital stay. With Original Medicare it is covered only after at least three days as an admitted inpatient; days "under observation" don't count. Many nursing homes have a unit like this.
• Nursing home (long-term). Help with daily living, such as bathing, dressing and eating, for as long as it is needed. Medicare does not pay for this kind of long-term care.
• Home, with home health. Therapy and nursing visits at home for someone who mostly can't leave the house.

What we learned

Don't skip a level. If someone is getting therapy in the hospital, make the most of it, and ask about rehab before they leave. Once a person has gone home or to a nursing facility, getting back into hospital-level rehab is much harder, even with a doctor's support, because they may already be seen as having reached a certain point in their recovery.

Ask what the stay is called on paper. "Rehab", "the facility" and "a place to get stronger" can mean very different things. Ask for the type of care and the coverage in writing.

Ask before discharge day. A last-minute decision leaves fewer choices. There are also things about benefits that most families aren't told, and they are much easier to plan for early.

Questions to ask before you agree to a place

• What type of care is this: inpatient rehab, short-term skilled nursing, or long-term care?
• How many hours of therapy a day will they get, and from whom?
• Is the hospital stay inpatient or observation, and does that change what is covered?
• Is this place in the plan's network, and has the plan approved it?
• If they need more therapy later, what would the next step be?

Sources

• Medicare.gov — Inpatient rehabilitation care
• Medicare.gov — Skilled nursing facility care
• Medicare.gov — Long-term care
• Medicare.gov — Home health services