Rehabilitation focuses on function. Being able to continue to function is key to maintaining or regaining independence and quality of life, particularly after an illness or injury. Starting rehabilitation early can help you maintain function and increase your chances of returning to your previous level of function as much as possible. In restorative rehabilitation, the goal is to restore a function that you have lost. It is often funded by Medicare or other payers. Examples include short-term rehabilitation that usually follows a stroke or a hip fracture. In maintenance rehabilitation, the goal is to maintain and strengthen a function. Maintenance rehabilitation is less intense, with physical therapy or occupational therapy continued three times a week as an outpatient. With longer-term therapy, possibly more function can be gained or more functional loss can be prevented.

Rehabilitation programs within hospitals or special rehabilitation hospitals use a multidisciplinary team approach, which involves the combined efforts of many specialists. The members of the rehabilitation team focus on different parts of health and manage different rehabilitation activities. The specific team members will vary significantly depending on the specific disability and situation.
In general, rehabilitation programs in these settings are for a short time. Depending on the person’s needs and anticipated improvement, inpatient rehabilitation programs usually last about 6—8 weeks for someone who has had a stroke, and about 2 weeks for someone who has had a hip fracture. A longer time is generally needed for those who have had more a severe injury, and a shorter time for those who have less complicated problems and were in good shape before becoming sick. Medicare reimbursement depends on documented progress as a result of therapy. The maximal length of stay is 90 days per illness. If you cannot tolerate or do not need an intense therapy program, you may receive services at a nursing facility, in your home, or as an outpatient. These programs may also be more appropriate for ongoing maintenance therapy after an inpatient rehabilitation program.

In a Nursing facility setting, maintaining function may be the goal of care. In contrast to the Medicare requirements for the hospital level of rehabilitation, the requirements for insurance coverage at the nursing level of rehabilitation do not include occupational therapy, a multidisciplinary approach, or the services of a rehabilitation physician. However, the requirements do specify that a person must need daily physical therapy and skilled nursing care and that continued, significant functional improvement must be documented. To be eligible for skilled nursing benefits through Medicare, the person must have had a hospital stay of at least 3 days in the past 30 days. The length of Medicare coverage for rehabilitation in nursing homes is limited.

Outpatient rehabilitation offers a wide range of services from private practitioners’ offices that offer fee-for-service care, to outpatient rehabilitation facilities that provide the same comprehensive team efforts as in hospital rehabilitation units. Generally, these outpatient units are appropriate for people with short-term illnesses, such as low back pain or minor trauma. Other services may be appropriate for people who need follow-up services after being discharged from a rehabilitation hospital or for whom an inpatient rehabilitation program is not suitable. Often, the availability of transportation is what determines whether the person can participate in an outpatient rehabilitation program.

Home-care rehabilitation programs can be an important part of follow-up care for people who have been discharged from any type of inpatient rehabilitation program. In addition, home rehabilitation services can help provide short-term or maintenance therapy. Medicare provides home-health benefits to patients who need intermittent or part-time skilled nursing care and therapy services, and who are homebound or leave the home only occasionally. Physicians must certify the person for services, but they are rarely involved in the supervision of care. There is no requirement for prior hospitalization, and there is no limit on the number of visits a person may receive but only for the time that the person needs to have a nurse come to his or her home. Home-health services provide skilled nursing and home-health aides, therapeutic services, medical and social services, and supplies.