Rehabilitation Options

Acute Inpt Rehabilitation (IPR) or Inpt Rehabilitation facility (IRF)

IPR involves a multidisciplinary team of physicians, physical therapists (PT), occupational therapists (OT), and speech and language pathologists (SLP)
Patients must require two of the three therapy disciplines listed above to qualify for IPR
Pts admitted to IPR must be able to tolerate a minimum of 3 hours of rehab per day for 5 days a week
Pts must have medical complexity warranting medical supervision by an IPR physician
Physicians are required to evaluate admitted pts at least 3 times a week
Average length of stay (LOS) in acute inpt rehab tends to be 10-14 days

Pts require skilled needs like wound care, IV therapy, catheter care, PT, OT, and/or SLP
There are no minimal requirements for daily therapy, but pts may receive up to 1.5 hours/day, depending on availability at the facility (in practice it is often much less than this)
Physicians are required to evaluate admitted pts at least once every 30 days
Average LOS is 26 days

Physical Medicine & Rehabilitation PM&R 473
Pts admitted to LTACH require extended hospitalization and include those who requires prolonged mechanical ventilation
Pts will be recommended for transfer to an LTACH when no reasonable functional or medical improvement can be expected in an IPR stay
LTACHs can be within a hospital or may be free-standing
Average LOS must be greater than 25 days

Pts receive a combination of long-term housing, personal care services, and health care
Designed for individuals who need assistance with activities of daily living
Can be provided in freestanding communities, near or integrated with SNFs, hospitals, or retirement communities

Can be ordered at discharge with or without official PT/OT recommendations
Home health (HH): wide range of healthcare services provided in pts home
HH PT/OT: therapy at home when unable to attend outpt PT/OT, usually ~1hr 2-3x/wk
HH nursing services: Required for IV antibiotics or PICC line maintenance; consider for wound care. Other services include medication adherence and reconciliation
HH non-skilled aide: outside the scope of acute hospitalization, but helps with ADLs
Outpt PT/OT: Consider for those who would benefit from therapy but do not meet the qualifications for other dispositions or would prefer outpt therapy. Often more robust PT/OT than HH due to access to the gym equipment.