Rehabilitation Setting Selection for Patients

Patient Suitability Criteria

• Patients who require and can tolerate intensive rehabilitation therapy are suitable for Inpatient Rehabilitation Facilities (IRFs), as they can achieve better functional outcomes, according to the American Heart Association 1, 2
• Patients with medical comorbidities requiring 24-hour physician availability and close supervision by a registered nurse with specialized rehabilitation training are also suitable for IRFs, as stated by the American Stroke Association 2, 3
• Patients for whom significant functional improvement is expected within a reasonable timeframe are preferred candidates for IRFs, as per the American College of Physicians 1, 3
• Patients who are likely to return to a community setting after discharge rather than requiring transfer to another inpatient facility are ideal candidates for IRFs, according to the American Medical Association 1, 3
• Patients who require a coordinated interdisciplinary team approach including rehabilitation physicians, therapists, nurses, case managers, and social workers are well-suited for IRFs, as recommended by the American Academy of Physical Medicine and Rehabilitation 4, 5
• Patients who may not reach full or partial recovery but require skilled nursing services to maintain function or prevent deterioration are suitable for Skilled Nursing Facilities (SNFs), as stated by the American Geriatrics Society 1, 3
• Patients who cannot tolerate intensive rehabilitation due to frailty or comorbidities are more suitable for SNFs, according to the American Medical Directors Association 4, 5
• Patients with less rehabilitation potential who still require daily skilled nursing or rehabilitation services are preferred candidates for SNFs, as per the American College of Rehabilitation Medicine 1, 2

Staffing and Supervision Differences

• Direct physician supervision with daily physician visits is typically required in IRFs, as recommended by the American Academy of Physical Medicine and Rehabilitation 1
• Physicians in IRFs are expected to have training or experience in rehabilitation, according to the American Board of Physical Medicine and Rehabilitation 1
• Registered nurses in IRFs are present continuously, often with specialty certification in rehabilitation nursing, as stated by the American Association of Neuroscience Nurses 1
• Interdisciplinary team conferences are required at least every 2 weeks in IRFs, as per the American College of Rehabilitation Medicine 3
• Documentation of patient progress, problems impeding progress, and solutions is required in IRFs, according to the American Medical Association 3
• Rehabilitation nursing is required on site for a minimum of 8 hours per day in SNFs, as stated by the American Nurses Association 1
• Care in SNFs must follow a physician's plan, but no requirement for direct daily physician supervision exists, according to the American Medical Directors Association 1, 3
• Less intensive medical oversight is compared to IRFs in SNFs, as per the American College of Physicians 1

Rehabilitation Intensity and Duration

• A minimum of 3 hours of rehabilitation therapy per day for at least 5 days per week is required in IRFs, as recommended by the American College of Sports Medicine 1, 2
• More intensive therapy regimen with higher frequency of treatment is provided in IRFs, according to the American Physical Therapy Association 1
• Shorter average length of stay (median of 15 days) is typical in IRFs, as stated by the American Hospital Association 6
• No minimum requirement for therapy hours exists in SNFs, as per the American Medical Association 1
• Generally less intensive therapy is provided in SNFs compared to IRFs, according to the American Occupational Therapy Association 4, 5
• Longer length of stay, dependent on individual patient needs, is typical in SNFs, as stated by the American Geriatrics Society 6
• Medicare provides coverage for up to 100 days in SNFs, as per the Centers for Medicare and Medicaid Services 1

Clinical Decision-Making Algorithm

• Assessing a patient's rehabilitation potential, including their ability to tolerate 3 hours of therapy daily and expected significant functional improvement, is crucial in determining the suitable rehabilitation setting, as recommended by the American College of Physicians 1, 2
• Evaluating medical needs, including daily physician supervision and complex medical needs requiring 24-hour specialized nursing, is essential in deciding between IRF and SNF, according to the American Medical Association 1, 3
• Considering functional status, including moderate disability and ability to participate in therapy, is vital in selecting the appropriate rehabilitation setting, as stated by the American Academy of Physical Medicine and Rehabilitation 4, 5