A typical stay in a non-hospital short-term rehabilitation facility is three or four weeks. It helps to know what to expect during that time. One significant issue that is important to understand early in your stay concerns how long you can remain there. Facilities certified by Medicare typically follow Medicare rules regarding when to discharge you. Even if you have private insurance and are not relying on Medicare, other insurance programs often follow Medicare's lead on this point.
If you refuse to participate in the therapy ordered for you, often that refusal is enough to get you discharged. Medicare's stance seems to be that they are paying for you to get rehabilitation services. If you decline those services - which may be scheduled for hours every day - there's no reason for them to pay for you to stay in a rehab facility.
One major issue that often leads people to be discharged before they expect or want to be is the requirement that the therapy you receive generally lead to weekly improvement in your condition. It is not enough that you believe that it is helping or that you want to continue it.
The medical professionals need to document your continual progress against treatment goals established up front. These are typically very specific and objectively measurable. They are intended to restore basic functioning. The treatment goals are typically not something like, "Restore the patient to full health." That is, if you could run a 6-minute mile before you were in an automobile accident, you won't get to stay in short-term rehab until you can run that fast again, even if you make progress every day.
Rehab goals are more modest, designed to restore you to a minimum level of functioning consistent with your pre-incident abilities. For example, they may focus on helping you reach the point where you can get out of bed, use the toilet, bathe and dress yourself, manage utensils so that you can eat meals, stand for 10 minutes so that you can safely handle tasks in the bathroom and kitchen, and so forth. If you could not do those things before you had the illness/ surgery/injury that landed you in rehab, then the goals will be more modest.
"One of the biggest gaps between what people expect and what actually happens is that they think they can stay until they are restored to their pre-hospital condition," observed Allene Young, social services/marketing director at Good Samaritan Society's skilled nursing unit in Prescott. "But that isn't the case."
Additional information about Medicare's (very limited) coverage of care in skilled nursing facilities, which is where non-hospital residential short-term rehabilitation is delivered, can be found in the brochure "Medicare Coverage of Skilled Nursing Facility Care" at http://www.medicare.gov/Pubs/pdf/10153.pdf.
As soon as you are admitted to the rehab facility, it's important that you or your advocate start thinking about where you will go next. A common mistaken expectation concerns the availability of space in a short-term rehab or long-term care facility of a retirement community in which you have previously expressed interest.
A senior executive at such a campus said, "People get on our waiting list, but they aren't ready to move from their house even when we have space in independent living. So they stay on our 'waiting list' for years. Then something happens - they fall and break a hip, for instance. Then they assume that we will have room for them in short-term rehab and then a few weeks later in long-term care or assisted living. But sometimes every bed is taken. Then they are disappointed. They say, 'But I'm on your waiting list!'"
Two mistaken as-sumptions that this objection reflects are, first, that being on a waiting list means that a space will be held vacant for you for years; and second, that there is any connection between an independent living waiting list and space available in skilled nursing/rehab/nursing.
While retirement communities do their best to accommodate people who need the care they have to offer, there is simply no guarantee that they will have space if you need it on short notice. It can pay to have a Plan B, such as becoming familiar with more than one site.