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Nursing homes aren’t enough

By Dr. Richard Senelick

There was a time in the 1980s when nursing homes just changed their signage and started to represent themselves as rehabilitation facilities. Almost overnight, the sign that said ABC Nursing Home was taken down and a new one proclaiming ABC Rehabilitation Center was erected. But, the mere changing of a sign does not change what takes place inside the building.

The impetus was purely financial and without any knowledge of whether nursing homes could do the work as well as long-standing rehabilitation hospitals.

As early as 1997, a major study in the Journal of the American Medical Association compared stroke patients who received their rehabilitation at a rehabilitation hospital versus a skilled nursing facility: Those receiving their rehabilitation at an IRF were three times more likely to be discharged home. That’s right: Three times more likely to sleep in their own bed, eat with their families and kiss their grandchildren goodnight! Knowing this, where would you want to go if you had a stroke?

Patients and families must become informed consumers. They need to know the difference between rehabilitation at a skilled nursing facility and an inpatient rehabilitation hospital. Too often they are not given a choice and must go where they are told.

There will be increasing pressure for people to sign up for Medicare Advantage programs that eliminate choice. Based on what they can afford, many people will be forced to sign up for these plans, but you still need to insist on a higher and better level of care.

If health care providers and consumers ignore this important issue, the disabled will not have a voice, and they will continue to be denied the services they need.

“Secondary to dying, nursing placement for an older person who was in the community is the worst possible outcome.”[PDF]  – Kramer et al, “Stroke Rehabilitation in Nursing Homes”

Families must know: Case managers are frontline decision-makers who recommend where patients go for rehabilitation. The decision they make may decide whether a patient truly gets the best opportunity to reach their potential.

Most skilled nursing centers are constrained by fewer resources and do not have access to the latest technology that helps promote neural plasticity and repair than an inpatient rehab hospital. Continued improvement and success in rehabilitation is dependent on the hours of therapy: Skilled nursing facilities typically provide less than half the therapy hours provided at an inpatient rehabilitation hospital.

Read more from Dr. Senelick on evidence that shows rehabilitation hospitals bring a higher level of care.

Someone in the healthcare chain can easily make the false assumption that the patient will not improve and might as well go to a nursing home.  Yet, patients surprise us all the time with progress we never could have predicted. Remember it is not too late for them to be what they can be if they get the proper care.

Medical Director of the Rehabilitation Institute of San Antonio, Editor in Chief of HealthSouth Press, and the author of more than 15 nonfiction books, Dr. Senelick is one of the leading experts on neurorehabilitation. Dr Senelick also contributes to the Huffington Post and WebMD’s stroke community.

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