Inpatient Rehab Guidelines

Understanding Inpatient Rehabilitation

Inpatient rehabilitation is an integral part of the healthcare system, offering crucial support to patients recovering from various medical conditions. This section aims to delve into the specifics of what constitutes inpatient rehab and the typical length of stay in such facilities.

What Constitutes Inpatient Rehab?

Inpatient rehabilitation is a specialized form of intensive therapy, typically administered in a dedicated facility. It involves patients participating in a substantial amount of therapy per week, with the aim of maximizing their participation in rehab with decreased pain and improved endurance. According to Sheltering Arms Institute, the ideal schedule includes about three hours of therapy per day, five days a week, totaling 15 hours per week.

However, recognising that some patients may need time to build up their endurance, alternate schedules can be provided. These may consist of just over two hours of therapy per day, spread across seven days a week. It's crucial for patients to have a high level of personal motivation as it leads to better outcomes by encouraging full participation in therapy [1].

Length of Stay in Inpatient Rehab

The average length of stay for inpatient rehabilitation varies depending on the patient's condition and the type of therapy required. According to the Center for Medicare Advocacy, as cited by Optalis Healthcare, the average length of stay for inpatient rehab, including joint replacement and stroke, is 12.4 days.

It's important to note that the first 20 days of inpatient rehab are covered in full by Medicare. However, the length of stay often depends on an individual's medical needs and condition. Patients seeking rehabilitation services typically have two options: an Inpatient Rehab Facility (IRF) or a Skilled Nursing Facility (SNF). The choice between these options should be based on the individual's specific needs.

In conclusion, understanding inpatient rehab and its guidelines is key to ensuring patients receive optimal care, leading to better recovery outcomes.

Guidelines for Inpatient Rehab

Understanding the guidelines for inpatient rehabilitation is crucial for those considering this type of care. Two important aspects to consider are the role of Medicare and the recommended frequency and intensity of rehab therapy.

Medicare and Inpatient Rehab

Medicare plays a significant role in covering the costs of inpatient rehabilitation. According to Optalis Healthcare, the average length of stay for inpatient rehab is 12.4 days, encompassing a range of rehab types such as joint replacement and stroke rehabilitation. Importantly, Medicare covers the first 20 days of inpatient rehab in full.

These statistics provide useful benchmarks for patients and their families when planning for inpatient rehab. However, it's crucial to remember that individual circumstances can vary significantly, and the specific duration and costs of rehab can differ accordingly.

Read: Inpatient vs Outpatient Rehab

Rehab Therapy: Frequency and Intensity

The frequency and intensity of therapy in inpatient rehab are key factors that contribute to the effectiveness of the rehabilitation process. Sheltering Arms Institute highlights that inpatient rehabilitation typically involves patients participating in 15 hours of therapy per week. Ideally, this consists of three hours per day for five days a week, aimed at maximizing the patients' participation in rehab with decreased pain and improved endurance.

For patients still building up their endurance, an alternate schedule may be provided, consisting of just over two hours of therapy per day, seven days a week. This flexible approach allows for a more personalized and effective rehabilitation process.

Comparatively, patients in a skilled nursing facility generally receive one to two hours of therapy per day, which is not classified as intensive. On the other hand, patients in an acute inpatient rehab hospital receive a minimum of three hours per day, five days a week, of intensive physical, occupational, and speech therapy.

In summary, when considering inpatient rehabilitation, it's important to understand these guidelines. Medicare can help cover a significant portion of the costs, and the frequency and intensity of therapy play a crucial role in the overall effectiveness of the rehabilitation process. These factors can help guide patients and their families in making informed decisions about inpatient rehab.

Inpatient Rehab Team

An integral part of the inpatient rehab guidelines is the team of professionals that handle the rehabilitation process. Understanding their roles and the collaborative approach they employ in rehab settings is essential to grasping the overall structure and functioning of inpatient rehab.

Roles of Inpatient Rehab Professionals

Inpatient rehab professionals have distinct roles that cater to the varying needs of patients. Their joint efforts are aimed at optimizing physical, mental, and social wellbeing of patients. They utilize individualized goal-setting approaches, support self-management and secondary prevention, and deliver needs-led, cost-effective, and efficient rehabilitation services. Their roles revolve around the ten principles for good rehabilitation intervention developed by the Rehabilitation Team within NHS England [4].

The team may include:

1. Physicians: They oversee the entire treatment plan, manage medical issues, and coordinate with other team members.
2. Nurses: They provide round-the-clock care, monitor the patient's health, and educate the patient and their family about the condition and care procedures.
3. Physical Therapists: They help the patient regain physical abilities like walking, balance, and strength.
4. Occupational Therapists: They assist the patient in relearning daily activities such as eating, dressing, and bathing.
5. Speech Therapists: They work on problems related to speech, swallowing, and cognitive issues.
6. Psychologists: They help handle emotional and psychological aspects of recovery.
7. Social Workers: They assist with practical issues like arranging home care, insurance, and transportation.

Collaborative Approach in Rehab

A collaborative approach in rehab is critical for the success of the intervention. This approach promotes partnership working, where every member of the rehab team contributes their expertise towards the patient's recovery. Effective communication within the team and with other medical disciplines needs to be established to foster beneficial relationships for patient care as well as to minimize misunderstandings in the decision-making process for IPR admissions.

Moreover, this collaboration extends to include the patients themselves. Rehabilitation interventions require patient motivation and adherence to be effective. The success of interventions is dependent on the commitment and engagement of the patients receiving the services [4].

In summary, the inpatient rehab team plays a critical role in the recovery process. By working together and leveraging their unique skills, they can provide comprehensive care that addresses all aspects of a patient's wellbeing. This collaborative approach is at the heart of effective inpatient rehab guidelines, ensuring that patients receive the best possible care during their recovery journey.

Rehabilitation Outcome Measures

The success of an inpatient rehabilitation program is determined by specific outcome measures. These measures assess the patient's progress and help tailor the treatment strategy to achieve optimal results. Two of the most common measures used are the Functional Independence Measure (FIM) and Rehabilitation Measure of Outcome (RMOs).

Functional Independence Measure (FIM)

The Functional Independence Measure (FIM) is the most studied and validated rehabilitation outcome measure used in Inpatient Rehabilitation Facilities. The FIM assesses the patient's ability to perform 13 motor and 5 cognitive tasks independently. Each task is rated on a scale from 1 (Dependent) to 7 (Independent).

The FIM scale is non-linear, meaning that not all score intervals are weighted equally. Intervals 2-3, 3-4, 4-5, and 5-6 are weighted equally, while intervals 1-2 and 6-7 are weighted three times as much. This scale can also be used to estimate participation and the associated impact on caregivers.

Rehabilitation Measure of Outcome (RMOs)

Rehabilitation Measure of Outcome (RMOs) are another crucial component in assessing the progress of a patient in an inpatient rehab setting. RMOs are vital to the practice of evidence-based rehabilitation medicine and must be defined for each domain and contextual factors of health conditions [6].

RMOs are developed to address specific rehabilitation goals and are often customized based on the health condition being treated. These measures are subject to inter-rater variability, and to minimize errors, biomechanical measures using kinematic and kinetic techniques are gaining prominence [6].

One of the latest national-level outcome measures used in the post-acute care setting is Section GG. This measure reflects the need to unify functional assessment across rehabilitation levels of care.

Both FIM and RMOs serve as essential tools in guiding the treatment plan, measuring progress, and optimizing outcomes in inpatient rehab settings. By understanding and appropriately utilizing these measures, health professionals can ensure that their patients receive the most effective and personalized care possible.

Inpatient Rehab Facilities (IRFs) vs Skilled Nursing Facilities (SNFs)

When considering inpatient rehab guidelines, a key aspect is understanding the difference between Inpatient Rehab Facilities (IRFs) and Skilled Nursing Facilities (SNFs). These two types of facilities serve different purposes and offer varying levels of care.

Services and Care in IRFs and SNFs

Both IRFs and SNFs provide 24/7 nursing care, but the intensity and type of care vary significantly. In a SNF, the nurse-to-patient ratio is 1:20 to 30, with a registered nurse present for 8 hours. On the other hand, in an IRF, the ratio is 1:6 to 7, with a registered nurse always on duty and Certified Rehabilitation Registered Nurses providing care.

In terms of therapy, patients in a SNF generally receive one to two hours per day of physical, occupational, and speech therapy, which are not classified as intensive. Conversely, patients in an IRF receive a minimum of three hours per day, five days a week, of intensive physical, occupational, and speech therapy [3].

As for physician care, in a SNF, an attending physician performs an initial assessment within 30 days of admission and is required to visit once every 30 days. In contrast, in an IRF, physician care is available 24/7, with a rehabilitation physician visiting at least three times a week to assess progress and goals.

Moreover, an IRF provides a highly trained, multidisciplinary personal rehab team consisting of various healthcare professionals like rehabilitation physicians, internal medicine physicians, nurses, therapists, care managers, dietitians, psychologists, and family members to determine goals and individualized treatment approaches [3].

Choosing Between IRFs and SNFs

When choosing between an IRF and a SNF, consider the patient's needs and the intensity of care required. The national average length of stay at a SNF is 28 days, while at an IRF, the average length of stay is 16 days.

Patients who require a higher level of care, more intensive therapy, or have complex medical conditions may benefit more from an IRF. On the other hand, SNFs may be suitable for patients who require less intensive therapy or whose medical conditions are stable. Always consult with healthcare professionals to make the most appropriate decision.

Understanding the differences between these two types of facilities is crucial when navigating the inpatient rehab guidelines and making informed decisions about rehabilitation care.

Impact of Therapy on Addiction

The pivotal role of therapy in the treatment of addiction cannot be overstated. Therapy sessions, which may range from a few encounters to a span over years, are crucial in helping individuals understand and manage their substance use disorders. They also address any underlying mental health conditions and physical/mental damage caused by addiction [7]. Therapy for addiction can be categorized into evidence-based therapies (supported by research) and alternative therapies (not verified through research studies).

Evidence-Based Therapies

Evidence-based therapies are protocols that have been supported by research and have been shown to be effective in treating addiction. Some of the most common evidence-based therapies include cognitive behavioral therapy (CBT), motivational interviewing (MI), and eye movement desensitization and reprocessing (EMDR) [7].

• Cognitive Behavioral Therapy (CBT): CBT is a type of psychotherapy that helps individuals identify and change thought patterns that lead to harmful behaviors. It is often used to treat addiction because it can teach individuals new ways of thinking, behaving, and coping with stress.
• Motivational Interviewing (MI): MI is a counseling method that helps individuals resolve ambivalent feelings to find the internal motivation to change their behavior. It is particularly effective in the treatment of addiction because it helps individuals identify their readiness to change and move through the stages of change.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a psychotherapy treatment designed to alleviate the distress associated with traumatic memories. EMDR can be particularly effective in treating addiction because it can help individuals process traumatic experiences that may contribute to their substance use disorder.

Alternative Therapies for Addiction

While not verified through research studies, alternative therapies have shown promise in treating addiction. These therapies, including music and art therapy, acupuncture, yoga, and recreational therapy, offer unique approaches to treatment that can complement traditional methods.

• Music and Art Therapy: These therapies provide outlets for self-expression, help reduce stress and anxiety, and promote overall well-being. They can be beneficial for individuals in recovery from addiction as they provide creative outlets for emotion and stress.
• Biofeedback Therapy: Biofeedback therapy focuses on the connection between the mind and body, helping people control voluntary responses of the body to improve overall wellness. It doesn't use medication and instead measures skin temperature, muscle tension, and neurofeedback. With trial and error, patients learn to make minuscule body adjustments that change muscle tension, blood pressure, and heart rate, leading to relaxation and overall wellness.
• Psychotherapy: Also known as talk therapy, psychotherapy is a treatment method that aims to increase overall mental health and well-being. It can help individuals change behaviors associated with substance abuse by identifying root problems and working through them through in-depth, analytical discussion [7].

In conclusion, the impact of therapy on addiction is profound. Whether it's evidence-based or alternative, therapy plays a crucial role in helping individuals overcome addiction and lead healthier lives. The choice of therapy should be made in consultation with healthcare professionals, considering the individual's unique needs, preferences, and circumstances.

Future of Inpatient Rehab

As advances in technology revolutionize healthcare delivery, inpatient rehab is also evolving to meet the changing needs of patients. Two significant trends shaping the future of inpatient rehab are the increasing use of telehealth services and the ongoing efforts to improve the rehab system.

Telehealth in Inpatient Rehab

Telehealth, an umbrella term encompassing telemedicine and telerehabilitation, is showing promise for its potential to reshape inpatient rehab guidelines. It allows for long-distance assessment and clinical care, significantly improving access to care for patients who might otherwise face barriers due to geographical limitations or other factors. This is particularly beneficial for individuals in rural areas or those who experience barriers to in-person care [8].

In addition to serving patients, telehealth services can also extend support to family caregivers of individuals in rehab. Through virtual consultations and remote monitoring, caregivers can stay informed about the patient's progress and receive necessary guidance on managing care at home.

The rise of telehealth reflects the healthcare industry's shift towards more patient-centered care. By leveraging technology, it bridges gaps in service delivery and makes inpatient rehab more accessible and convenient for patients and their families.

Improving Inpatient Rehab System

Despite the advancements in inpatient rehab, there remain key gaps that need to be addressed to further improve care and outcomes for patients. For instance, the current Traumatic Brain Injury (TBI) post-acute care and rehabilitation system is fragmented, making it inaccessible to many patients. It is not optimally designed to meet the evolving needs of individuals with TBI and their families.

Efforts to improve the inpatient rehab system should focus on enhancing coordination between different care providers, making rehab services more accessible, and tailoring care plans to cater to the unique needs of each patient. By addressing these areas, the rehab system can evolve to deliver more effective and patient-centered care.

Indeed, the future of inpatient rehab lies in harnessing the potential of technology and continuously refining the system to deliver better care. By doing so, it will continue to play a vital role in helping patients recover and regain their independence.

References

[1]: https://www.optalishealthcare.com/what-is-the-average-length-of-stay-for-rehab-2/

‍[2]: https://shelteringarmsinstitute.com/about-us/why-inpatient-rehabilitation/

‍[3]: https://www.mainlinehealth.org/specialties/rehabilitation/inpatient/snf-vs-acute-rehab

‍[4]: https://www.physio-pedia.com/Rehabilitation_Interventions

‍[5]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298344/

‍[6]: https://now.aapmr.org/outcome-measurement-in-rehabilitation/

‍[7]: https://www.rehabspot.com/treatment/clinical/types-of-therapy/

‍[8]: https://www.ncbi.nlm.nih.gov/books/NBK580075/