Op-Med is a collection of original articles contributed by Doximity members.
Inpatient rehabilitation facilities (IRFs) provide comprehensive and intensive inpatient rehabilitation and ongoing medical management to individuals with functional impairments following disabling illnesses and injuries. Although many physicians refer their patients to IRFs, many misconceptions about these rehab programs persist.
Here are the 10 most-frequent myths and misconceptions I’ve encountered across the medical field:
Myth #1: Patients can stay on the rehabilitation unit for many months.
While this may have been the case many years ago, the average length of stay these days is around two weeks. Keep in mind that this average includes patients with massive strokes, severe traumatic brain injuries, and new spinal cord injuries, who generally have longer lengths of stay. As such, a patient that is less complicated from a rehabilitation standpoint, such as someone with general debility after pneumonia or who is recovering from a fracture, may have a significantly shorter length of stay.
Myth #2: Patients will be 100% back to normal by the time they leave rehab.
While some patients do regain their functional independence by the time they are discharged from rehab, many do not and cannot. The rehab team will work with each patient to come up with appropriate, individualized goals, based in part on diagnosis, types and severity of functional impairments, and progress early on in the rehabilitation process. A patient, for example, with a new spinal cord injury resulting in complete paraplegia will not achieve his prior level of function during his time in inpatient rehab. Rather, such a patient will need to learn to perform his bladder and bowel care, transfers, and wheelchair mobility so that he can safely care for himself in his home environment.
Myth #3: Rehab facilities don’t accept admissions on weekends and holidays.
There may remain some facilities that do not, but many do admit on weekends and holidays. It may not be possible, however, to get insurance authorization for a rehabilitation admission after 5 p.m. on a Friday. In such cases, there is little the rehabilitation team can do. If you anticipate your patient may be ready for rehab admission during a weekend or holiday, it is best to place the referral in advance.
Myth #4: It’s always cheaper to send someone to rehab than to keep them on a medical/surgical unit.
Providing patients with three hours of 1-on-1 therapy daily is quite expensive. As such, inpatient rehabilitation is cost-effective only if the patient needs the rehabilitation and is anticipated to make functional gains, or at least have family learn their care so that they can provide it at home. It is not a cheap place to house patients who simply lack disposition.
Myth #5: Medicare patients must have a 3-day hospitalization before transferring to an inpatient rehabilitation facility.
While a patient must have a qualifying hospitalization of three or more days before they may be covered for care in a skilled nursing facility, this rule does not apply to patients going to an IRF. Patients can be admitted any time once they are medically appropriate and able to participate in, and benefit from, their therapy programs. IRFs can even admit patients directly from home if warranted.
Myth #6: IRFs are good places to send your patients with drug and alcohol problems to sober up.
Nope. Wrong type of rehab. That is, unless they sustained some disabling injury or illness while intoxicated that may necessitate intensive physical, occupational, and/or speech therapy.
Myth #7: If it’s unclear if a patient can tolerate/benefit from an IRF, it’s okay to admit them on a trial basis.
Medicare used to allow for a rehab admission of up to 10 days to assess whether a patient was appropriate for this level of care. This provision no longer exists. Now, IRFs can only admit Medicare patients they expect to meet all criteria and benefit from the care they provide.
Myth #8: The right time to admit the patient for rehab is always when the hospital team is ready to discharge them.
Most rehab facilities go to great lengths to admit patients expeditiously. There are, however, circumstances where their ability or willingness to admit may not align with the plans of the discharging service. Often, this is because the patient has not yet demonstrated the ability to tolerate and/or benefit from the intensive therapies provided. This could be due to uncontrolled pain or severe orthostatic hypotension with attempts to mobilize. On some occasions, it is because the patient requires a medical intervention that the rehab facility is unable to provide — for example, IV pushes of anti-hypertensive medications.
Myth #9: Rehab is a great place to complete medical work-ups that didn’t get done on the med/surg floor.
In general, necessary medical work-ups should be done before transferring to rehab, unless they can wait and be done as an outpatient. Tests and procedures can greatly interfere with a patient’s therapy schedule. In some cases, they will require prior authorization to be performed while on rehab. Other times, they may not be reimbursed at all.
That being said, when a patient’s condition changes and warrants evaluation while in rehab, the rehabilitation team will work-up as necessary.
Myth #10: Rehab is a depressing place.
Quite the contrary. Rehab is where patients go once their conditions improve to try to regain their independence. While it is not uncommon to see tears and signs of frustration on rehab, there is little in medicine so uplifting and inspiring as seeing someone who has overcome great hurdles achieve their goals!
Lauren T. Shapiro, MD, MPH is an Assistant Professor of Clinical Physical Medicine and Rehabilitation at the University of Miami. She is board-certified in PM&R and Brain Injury Medicine. She is also a 2017–2018 Doximity Fellow.