About seven weeks after Joan had a medical procedure followed by a variety of complications, she was once again preparing to leave the hospital. Experience had shown that a skilled nursing facility wasn't necessarily going to be able to meet her very extensive needs. But where else could she go? To get the care she needed, Joan was sent to a rehabilitation hospital.

Also known as "inpatient rehabilitation facilities" or IRFs, these specialized sites operate under tight federal regulation to admit and treat patients who in the majority of cases have certain specific, severe medical problems that call for a high level of medical attention; require several different types of intensive treatment such as physical, occupational and speech therapy; generally need these services to be delivered one-on-one rather than in a group; can benefit from getting such therapy for at least three hours every day; are able to actively participate in the treatment; and are expected to rapidly improve in their ability to handle basic tasks such as walking, bathing, dressing, and other "activities of daily living."

Facilities are required to complete a very comprehensive evaluation of all patients seeking admission before agreeing to admit them, to make sure that they meet all the federal requirements.

Some of the medical conditions/events that can lead to a stay in a rehabilitation hospital are strokes, spinal cord or brain injuries, hip fractures, amputations, burns and extensive trauma such as that resulting from a serious automobile accident. In 95 percent of the cases, people are admitted to a rehabilitation hospital directly following a stay in a regular hospital.

Under current rules, joint replacement patients must have one or more complicating factor to be eligible for treatment in IRFs. Examples include having both knees replaced at the same time, or having a body mass index greater than 50 - which for someone 5'9" means a weight of about 340 pounds. Today, the most common reason for admission to a rehabilitation hospital is to get help recovering from a stroke.

Patients in IRFs will see a doctor who specializes in physical medicine and rehabilitation and who evaluates their status at least three times a week, to see how they are progressing and to make any mid-course corrections needed to increase their chances of successfully completing their treatment program and getting the desired results.

Doctors aren't the only ones involved in constant evaluation of a patient's condition and progress. At least once a week, a whole team must meet to discuss the patient's progress, note any obstacles that may be getting in the way, come up with plans to remove those obstacles, and decide if treatment goals need to be adjusted.

Who shows up for these weekly meetings? A doctor and a nurse, both with specialized training in rehabilitation, a social worker and/or a case manager, and a qualified professional from each different therapy department treating the individual all get together for these conferences.

The care plan created has to list every type of treatment the patient is expected to get, and how many hours a day and days per week those treatments will occur. The plan also has to explain in detail exactly what improvements in functioning the patient is expected to gain, and how long the patient is forecasted to stay in the facility. It also has to note where the patient is expected to go after leaving the rehabilitation hos-pital.

As of 2010, according to a report to Congress from MedPac, an independent congressional agency, there were about 1,180 such facilities. Why have you never heard of them? About 80 percent of IFRs are associated with hospitals, and it is possible that the distinction between an inpatient rehabilitation wing and the rest of the hospital isn't obvious to the casual observer. The other 20 percent of IRFs are freestanding - which means that there are only about 240 of them nationwide.

In north-central Arizona, there is only one freestanding inpatient rehabilitation facility, Mountain Valley Regional Rehabilitation Hospital in Prescott Valley. That is where Joan was sent when her problems required more attention than a skilled nursing facility was prepared to provide. Next week's column will provide more information about Mountain Valley.