How to understand your rehab recommendation and what comes next

A hospital stay can end with a new question: What happens next?

For some patients, the answer includes rehabilitation. Your care team may recommend inpatient rehab, a skilled nursing facility, home health, or outpatient therapy based on what you need at that point in recovery.

“Typically, the care team will make a recommendation,” says Brandon Taylor, MS, CCC-SLP, rehab manager for inpatient rehabilitation at Intermountain Health’s St. George Regional Hospital. “I think it’s appropriate to ask why that’s the recommendation.”

It’s about understanding what they’re seeing, why a certain level of care fits your needs, and what everyone is working toward.

How do care teams decide which level of rehab you need?

Certain conditions commonly lead to inpatient rehabilitation, including stroke, spinal cord injury, and traumatic brain injury. Taylor says patients recovering from amputations, serious car crashes, orthopedic injuries, cardiac conditions, and other illnesses or injuries may also benefit.

A rehab recommendation usually reflects several parts of your health and recovery at the same time.

• Your care team will first look at your diagnosis. They’ll consider how much medical oversight you still need, how much therapy you can safely participate in, and how independently you can manage everyday activities.
• Your team also looks at what you can do right now. Can you get out of bed safely? Walk? Get dressed? Bathe? Use the bathroom? Prepare food? Communicate what you need? Those everyday abilities help show how much support and rehabilitation may help you make progress.
• Your home situation matters, too. Someone who lives alone may need a different plan than someone with family nearby. A spouse may want to help but may not be able to provide physical assistance or around-the-clock supervision.

Sharing your goals and living situation, along with what support will realistically be available, helps your team see the full picture.

What are the different levels of rehabilitation care?

Different rehab settings provide different amounts of therapy, medical oversight, nursing care, and day-to-day support.

Inpatient rehabilitation provides intensive therapy along with physician, nursing, and other medical oversight. Patients generally need to be able to participate in three hours of therapy a day, five days a week. A modified program can spread 15 hours of therapy across seven days.

Inpatient rehab is not just about the number of therapy hours. The quality of therapy and its focus on functional, everyday activities are also important parts of helping patients work toward greater independence.

Patients may work with physical therapists, occupational therapists, and speech therapists, depending on their needs. The focus is often practical, including walking, dressing, bathing, cooking, communication, swallowing, memory, and other skills that support daily life.

A skilled nursing facility may be appropriate for patients who still need nursing care and rehabilitation but aren’t ready for the intensity of inpatient rehab. Patients who can tolerate only limited activity may need more time before taking on a more intensive program. Activity tolerance is only one consideration, and the care team will also evaluate the patient’s diagnosis, medical needs, current abilities, rehabilitation goals, support system, and other factors when recommending the most appropriate setting.

Home health brings care and therapy to patients who can return home but are homebound and need services there.

Outpatient rehabilitation may be appropriate for patients who are mobile enough to travel to a clinic and don’t need inpatient medical support.

Some patients may need ongoing nursing or daily living support if they aren’t able to participate in much rehabilitation.

“There can be situations where someone needs maybe long-term care,” Taylor says. “They’re not getting to a level where they’re able to participate in much rehab, and they need to consider long-term care options.”

Long-term care can include ongoing help with daily needs such as bathing, dressing, mobility, medications, or supervision. The type of support depends on the person’s needs and situation.

What should you ask about your rehab recommendation?

Once your care team makes a recommendation, asking questions can help you understand what that plan means for your recovery.

“The patient and the family are part of their care team,” Taylor says. “So ideally, they should be part of the discussion too.”

Questions worth asking include:

• Why are you recommending this level of care?
• What will therapy look like there, and how much will I receive?
• How much physician and nursing support will I have?
• What are we hoping I’ll be able to do by the time I leave?
• What role will my family or caregivers have?
• What is likely to come after this stage of recovery?
• What does my insurance cover, and what costs should I expect?

Those conversations also give you a chance to share information your care team needs.

If returning home is your goal, say so. If a caregiver is concerned about lifting, transfers, supervision, or how much help they can provide, bring that up. Transportation, finances, and available family support can all affect the plan.

Case managers and social workers can also help explain care options, answer insurance questions, and share resources that may be available.

What happens when your current level of rehab is ending?

Rehabilitation often happens in stages, and your needs may change as you gain strength, mobility, and independence.

Taylor encourages patients and families to ask about that longer view so they understand not only why a certain level of care is recommended now, but how it fits into the broader recovery plan.

A patient may move from the hospital to inpatient rehab, then continue with home health or outpatient therapy. Someone in a skilled nursing facility may later be ready for a different level of rehabilitation.

As each stage ends, the care team reassesses your medical needs, progress, function, and support system to help plan what comes next.

How Intermountain Health rehabilitation services support recovery

Rehab can feel complicated when you’re hearing these terms for the first time during an already stressful hospital stay.

“Don’t be afraid to ask questions,” Taylor says. “If you don’t understand something, speak up.”

Intermountain Health offers rehabilitation services for people recovering from illness, injury, surgery, or chronic conditions, with the goal of helping patients return to the best possible health.

To learn more, visit the Intermountain Health rehabilitation services page.