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Rehabilitation occurs at a pivotal point in the recovery process, so choosing the appropriate level of care is important. While many healthcare providers describe their services as rehabilitation, the level and intensity of care can vary greatly from one to the next.
This chart provides an explanation of acute vs. subacute rehabilitation services. These resources will help determine what is best for you or your loved one. Prior to admission at our inpatient rehabilitation hospital, Sheltering Arms Institute, one of our clinical referral liaisons or physicians will assess the patient to ensure that he/she can benefit from intensive inpatient physical rehabilitation services and to arrange for the transition to our hospital if appropriate.
|Inpatient Rehabilitation Hospital*||Skilled Nursing Facility||Long Term Care Hospital||Home Health||Outpatient Rehabilitation**|
|Length of Treatment||Average 10-18 days||Average 25 days||25 days or longer||Variable, based on treatment plan||Variable, based on needs|
|Therapy Intensity||Intensive, skilled care; often integrating advanced technologies||Less intensive than inpatient rehabilitation, but not regulated||As needed, usually low intensity||Variable, based on treatment plan||Variable, based on needs|
|Amount of Therapy||Typically 3+ hours per day||Typically 1-1.5 hours per day (up to 3 hours)||Variable||30-60 minutes per session & discipline, usually 3 times per week||30-60 minutes per session & discipline, 2-3 times per week|
|Physician Involvement||Daily face-to-face assessment and treatment plan update||At least every 30 days||Available, not on-site daily||Provide oversight but no direct treatment||As needed to evaluate progress and assess treatment plan|
|Skilled Nursing Care – RN||Care from RN 24 hours per day||RN on site for at least 8 hours/day, care typically provided by techs||24 hours/day||As needed per treatment plan||N/A|
* Offered at Sheltering Arms Institute, a collaboration with VCU Health.
** Offered at Sheltering Arms Outpatient Rehabilitation Clinics. Physician services are only offered in our concussions therapy program.
For people seeking rehabilitation services, there are typically two options: An Inpatient Rehab Facility or a Skilled Nursing Facility. Below is a chart that outlines the differences between these options to help determine which option best meets the person’s current medical and rehabilitation needs.
|Service||Inpatient Rehabilitation Facility (Hospital)||Skilled Nursing Facility|
|Physician Visits||Daily||1-3 times per week|
|Type of Physician||Physiatrist, a doctor who specializes in physical medicine and rehabilitation (24-hour availability||Geriatrician, internist, or family practitioner (Limited availability)|
|Consultants||All specialties readily available||Limited specialist availability|
|Nursing Hours of Care||5.5 and higher hours per day, primarily registered nurses (24-hour availability)||2-3 hours daily, primarily certified nursing assistants|
|Nursing Skill Mix||Professional registered nurses specializing and certified in rehabilitation nursing||Nursing assistants certified in long-term care with LPN/RN supervision|
|Function||Complex level of care, patient and family education||Basic level of care support|
|Integration of Care||Coordinated multidisciplinary team directed by physician||Several individual disciplines|
|Average Length of Stay||10-35 days, depending on diagnosis||24-60 days|
|Therapy Intensity||3 hours per day, 5 days per week||45-90 minutes, 3 times per week|
|Team Meetings||Multidisciplinary team meetings lead by physician including family||Several individual disciplines|
|Physical and Occupational Therapy||Registered physical and occupational therapists||Physical therapy assistants and certified occupational therapy aids deliver much of the care|
|Audiologist, Therapeutic Recreation, Social Worker||Full-time||Limited|
|Speech Language Therapist||Full-time||Limited|
|Quality Improvement||Quality Assurance/Utilization Review||None|
|Prosthetist/Orthotist||Evaluated by licensed clinician and accepted by medical doctor||Accepted by admissions|
Sources: DaVanzo, J. E., Ph.D., M.S.W., El-Gamil, A., Li, J. W., Shimer, M., Ph.D., Manolov, N., Ph.D., & Dobson, A., Ph.D. (2014). Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge [Abstract].
Inpatient rehabilitation refers to physician and therapy services received during a hospital stay. The majority of our patients come to us after being stabilized at an acute care hospital, but others are admitted directly from the community. Patients participate in intensive therapy for at least three hours a day, five or more days a week using cutting-edge rehab technology.
Diagnoses may include amputation, brain injury, cancer, generalized weakness, multiple joint replacement, multiple sclerosis, neurodegenerative disease, neuromuscular disorder, spinal cord injury, and stroke. Patients often have multiple medical complications that must be effectively managed to enable them to participate in therapy and set the tone for ongoing recovery.
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