When an older adult experiences a traumatic health event, whether it’s illness, surgery or the result of an accident — such as a fall — the road to recovery can look different, depending on a number of factors. Seniors often need rehabilitation to restore strength, mobility and independence, but the process may require special considerations based on factors such as health conditions and overall endurance.
During your or your loved one’s hospital stay, you will likely consult with a doctor called a physiatrist, who will consider the optimal rehab placement for you. They will take into consideration your “function and mobility prior to hospitalization, medical comorbidities, current level of function and mobility, level of assistance required, patient endurance level, family support and type of home,” says Dr. Rummana Aslam, chief of physical medicine and rehabilitation medicine at Yale Medicine and associate professor of orthopaedics & rehabilitation at Yale School of Medicine.
With that criteria in mind, as well as insurance coverage and personal preferences, the experts we spoke to share what the different types of rehab for seniors are and where you can access them.
What is senior rehabilitation?
For older adults, the purpose of rehab is to regain physical and/or cognitive function after a health incident, such as a stroke, surgery or a fall. Of the reasons you or an older loved one might need rehab, Dr. Michele Bellantoni, medical director of Johns Hopkins Bayview Specialty Hospital Programs and associate professor of medicine in the Division of Geriatric Medicine and Gerontology at Johns Hopkins University School of Medicine, says the most common for seniors is a fall and the “evidence of functional decline that led to that fall,” such as:
- Balance disorders.
- Gait disorders.
- Cognitive impairment.
- Neurologic conditions, like a stroke.
- Unplanned weight loss because of depression.
- Inadequate nutrition.
Depending on your therapy needs, you may require physical, occupational, speech-language or recreational therapy, or a combination of multiple.
- Physical therapy focuses on “mobility (e.g., walking, standing, climbing stairs and different types of balance — while sitting, standing and navigating spaces), as well as providing any equipment that one might need for mobility (cane, walker and wheelchair),” says Stephanie Fungsang, occupational therapist at McLean Hospital and Spaulding Rehabilitation Hospital.
- Occupational therapy covers “many aspects of self-care, or what we call activities of daily living (ADLs),” says Fungsang. She adds that these include “bathing, dressing, toileting, grooming, home management, meal preparation, leisure and more, in addition to the adaptive equipment one might need (long-handled reachers, shower or tub benches, bed rails, etc.). [Occupational therapists] also work on fine motor (use of hands) [skills] in order to complete those above activities.”
- Speech and language therapy is often called just “speech therapy,” but Bellantoni argues that this should actually be renamed because it covers so much more than just speech and language.
“Speech therapists evaluate and treat language and cognition, like speaking and thinking, memory, focus, attention, problem solving and executive functioning,” says Aslam. “They also evaluate and treat swallowing disorders,” she adds. - Recreational therapy helps “patients recover by engaging in music, art, games, sports or other interests, often in collaboration with the patient, their families and other therapy disciplines,” says Fungsang.
Fungsang shares an example of how multiple forms of therapy can work together: “The goal of independent self-care with bathing may involve physical, cognitive, environmental and activity interventions,” including:
- Increasing endurance, mobility and balance.
- Adapting the activity to be safe and manageable (i.e., seated vs standing, rest breaks).
- Learning to implement adaptive equipment.
- Problem solving, staying on task, and making safe choices throughout.
- Modifying the environment for safety and comfort.
Senior rehabilitation care options
Once you and your care team have determined rehab is necessary for your post-hospital stay care, there are a few options for where you can receive treatment.
Senior rehabilitation care options and what they offer
| Services | Inpatient rehabilitation facilities (IRFs) | Skilled nursing facilities (SNFs) | Home-based rehabilitation | Outpatient rehabilitation |
|---|---|---|---|---|
| Acute rehab | ✓ | ✓ | ✓ | |
| Subacute rehab | ✓ | ✓ | ✓ | |
| Medication administration | ✓ | ✓ | ✓ | ✓ |
| 24/7 medical staff | ✓ | ✓ | ||
| Skilled nursing care | ✓ | ✓ | ✓ | |
| Meals | ✓ | ✓ | ||
| Access to specialists | ✓ | ✓ | ||
| Social services or counseling available | ✓ | ✓ | ||
| Nutritional support | ✓ | ✓ | ||
| Medical tests | ✓ | ✓ | ||
| Pain management | ✓ | ✓ | ||
| Covered by Medicare | ✓ | ✓ | ✓ | ✓ |
| Covered by Medicaid | ✓* | ✓* | ✓* | ✓* |
| Long-term care insurance | ✓** |
** Plan coverage may vary, but comprehensive policies generally cover these services.
Inpatient rehabilitation facilities (IRFs)
The services at inpatient rehab facilities are intense, with patients required to tolerate three hours of rehab a day, five (or more) days a week. These facilities can either be free-standing rehabilitation hospitals, or they may exist as units within acute care hospitals, according to the Centers for Medicare & Medicaid Services.
The average length of stay is 2 to 3 weeks, according to Aslam.
Skilled nursing facilities (SNFs)
These facilities are a temporary living option (that often exist within a nursing home) for people who are receiving medical treatments or rehab after a hospital stay for an illness or injury, according to Medicare.gov.
The average length of stay is 4 to 16 weeks, says Aslam.
Outpatient rehabilitation
Unlike receiving rehab from IRFs or SNFs, with outpatient rehabilitation, you will continue to live at home. Any rehabilitation services you receive will happen in places, such as nursing homes, hospitals, physicians’ offices and rehab facilities, according to MedPAC.gov.
For outpatients, Aslam adds that your primary care provider can often direct the nature of your rehab, or get you a consult from a physiatrist.
Home-based rehabilitation
As the name suggests, home-based rehab means a rehab practitioner will come to you. Medicare covers home health part-time or intermittently if you are eligible and considered “homebound.” However, because you won’t have access to medical care outside of practitioner visits, you may need additional assistance at home, either from a family member or a paid caregiver.
How to choose the best option for senior rehab
When it comes to deciding where you’ll receive rehab, Fungsang says the choice really depends on your “diagnosis and needs, as well as [your] previous level of function (prior to any acute event).” For example, she asks, “Can [you] tolerate 3+ hours of therapy per day for 5+ days a week (i.e., IRF)? If not, a skilled nursing [facility] may be the best place for recovery. Are [you] medically stable enough to return home, but are unable to leave home independently (“homebound”) and need rehab? Home services may be the best fit.”
Aslam adds that there are other considerations, as well, when it comes to deciding if you can go home for rehab. It will depend on if you have help at home, if there are steps to navigate to get to your bedroom and bathroom, if the home is set up in a way that allows activities of daily living to be carried out safely, among other safety concerns.
Lastly, if your needs are more niche, Fungsang advises that you may be able to find what you need in an outpatient setting: There “you may find therapists that work in more specific, specialty areas, such as vestibular (for help with vertigo, dizziness, etc), pelvic floor, hands, vision, driving rehab and more.”
What are the benefits of proper rehabilitation?
“As we age, we lose muscle strength, balance and endurance,” says Lia Poynor, rehabilitation therapy manager at Goodwin Living in Alexandria, Virginia. “Rehabilitation therapy can help to improve all these features and prevent functional decline so that seniors can remain as independent as possible.
According to the American Geriatrics Society, it is recommended that adults ages 65 and older have a therapy evaluation annually to assess for any changes. Without any intervention, seniors are at increased risk for hospitalizations, falls and general debility. Therapy interventions can reduce risk and help seniors to thrive as they age.”
Aslam states that “the most significant benefit is to maximize independence in function and mobility, and to be able to take care of themselves with minimum to no assistance.”
How to navigate the financial costs
Because everyone’s coverage is different, whether you’re utilizing private insurance, Medicare, Medicaid or a combination, the experts we spoke to advised reaching out to your insurance company. However, Aslam adds that if you are inpatient in an acute hospital and needing rehab, “the rehab admission liaisons and coordinators, and often the consulting physiatrist, will go through insurance and find out what is covered and for how long.”
And while each situation is unique, Bellantoni does note that Medicare requires you to have been hospitalized for three nights before they will approve post-hospital inpatient rehab.
How to support seniors undergoing rehab treatment
Not dissimilar to a hospital stay, entering an inpatient rehab program — like at IRFs or SNFs — can have a difficult transition period, as most people just want to be in their own home. However, Funsang shared some ideas for making your loved ones stay easier:
- “Find ways to connect with your loved one, especially if you’re unable to visit in person, whether it’s making sure they have their cell phone (and charger!) accessible, or getting the direct line to their room phone.”
- “Bring them some of the comforts of home, such as pictures of family or home, comfortable clothes and a favorite blanket or pillow.” Don’t forget the necessities, too: glasses, hearing aids (and chargers), dentures, preferred toiletries and ear plugs if they’ll be sharing a room.
- “Be proactive in communicating with the team — to stay up-to-date on progress or any issues, to voice your own preferences and to advocate for your loved one. There should be a case manager or staff member that is your point of contact.”
- Bring a large calendar that shows “today’s date and major holidays, and how much time has passed since they were in the hospital.” Additionally, “notes from loved ones with encouraging words, or reminders of where they are (and why) can be reassuring.”
A final word on senior rehabilitation options
Whether you choose to receive rehab at an inpatient rehab facility, a skilled nursing facility, at home or as an outpatient service, the goal is the same: helping you regain strength and confidence to live as independently as possible.
“Rehabilitation is important for seniors to maintain their function and independence in their daily activities,” says Poynor.
By educating yourself on the differences between the ways you or your loved one can receive rehab, as well as your insurance coverage, you can support your loved one’s recovery and overall well-being.
