Top 11 Myths about Sub-Acute Rehab Hospitals

If you or a family member are planning to go to a Skilled Nursing Facility (SNF) or Rehab Hospital after getting injured or sick, there are a few things you need to know.

There is often a HUGE miscommunication regarding what you’ll be doing, how long you’ll stay, amenities, activities, etc…

Who knows where this breakdown in the info line is? I certainly don’t. It could be from either or both ends.

Disclaimer: The info on this post is for current rules and regulations. As we all know, healthcare changes frequently and may make some of these myths obsolete. 

What is Sub-Acute Care?

Before I get into what the myths are, let me go over what exactly Sub-Acute care is:

• The next step in your recovery cycle.
• Temporary until you are strong enough to move to your next destination (wherever that may be)
• A fully interactive experience (you will actively get tested on something every single day)
• Offers long hours of PT, OT, ST every day (yes, even on the weekends)
• Important!!!

Short answer: It is where you go when you aren’t sick enough to be at the hospital anymore, but not well enough to go home yet.

Disclaimer: There are a few rare cases in which someone goes to a rehab facility to get skilled nursing care (like wound care or infectious disease recovery) and not for therapy services. You’ll know before you go if that is your situation.

Myth 1: You’ll just be there a few days

The honest truth, no one knows how long you’ll be there. There are a lot of factors to consider before you go home. Typically your discharge date is set according to your CURRENT health and functional ability level COMPARED to what it was BEFORE you were hospitalized, AS WELL AS what assistance there is available for you at home.

To break that down. If you were wheelchair bound and had a part-time caregiver for 6 months before you went to the hospital, then you would most likely still be in a wheelchair and going home to a caregiver when you discharge. On the other hand, if you were 100% independent, driving around town and doing your own yardwork, then it is unlikely you will discharge home without help if you’re unable to stand for more 2 minutes at a time or walk to the bathroom alone yet.

Of course there are those few that leave AMA (Against Medical Advice) but that sort of thing often results in another trip back to the hospital to start the cycle all over again.

Not fun. Not recommended.

Myth 2: It’s just rest before you go home

Yes you will get rest, but not a peaceful quiet rest. Remember, it’s still a medical facility. That means strange alarms and beeping sounds, talking in the hallways, staff coming in and out to take vitals, provide therapy, give meds, clean, etc… Double all of that if you’re in a shared room.

This happens Around-The-Clock, 24/7, 365 days a year. There are no days off in healthcare.

But the main reason you won’t just be resting is in the title—> REHAB. That’s the whole point of being there, to get rehab services.

Myth 3: It’s like going to a spa

It’s a medical facility. You won’t be catered to, the food is institutional, the beds and pillows are NOT comfortable, there are medical sounds and smells everywhere and it is a busy place.

Myth 4: You can skip therapy if you don’t feel like it

Skipping therapy is a bad idea. It’s the whole reason you’re there! Missing just one day of therapy can set you back multiple days in recovery. If you have a limited time in the facility you need to make the most of it.

At the end of your stay, on your way home would you rather have spent less time getting better OR more time focusing on your health and functional ability levels.

There’s something about knowing you did the best you could. Skipping a service that will help get you to YOUR BEST doesn’t fit in that category.

That is really what therapy is all about. Getting you to the best you can be. Maximizing your potential.

If you are medically compromised then missing a day of therapy is justified. This will be documented and will not count against you when the insurance company audits your case. If you have no medical reasons for missing therapy then the insurance reviewer looking at your paperwork may decide you are well enough to go home sooner than you actually are. This is one of those frustrating times when they can justify a reason to stop paying for your care. Don’t give them a reason!

Myth 5: You can stay there 100 days

Currently the Medicare literature states you have up to 100 days. Anywhere from 1 to 100 days for the same event after a qualifying 3 day hospital stay.

Lets break this down: If you go to the hospital and stay past 3 midnights you should be able to go to sub-acute care paid. Paid at 100% for 1-20 days, and 80% for days 21-100. So for the day 1 through day 20, you don’t have to pay a penny. Day 21-100, you have to pay 20% of the total cost. Day 101->on, you have to pay for it yourself.

Your days start in the hospital. If you stayed in the hospital for 5 days before going to a rehab facility, then you only have 15 days left of fully paid care left until your copay kicks in.

If you have complications and have to go back to the hospital for the same medical situation and then come back, you are still in the same 100 day time frame.

It is honestly in your best interest to stay for the minimal amount of time necessary. Don’t use up your 100 days if you don’t have to. The clock resets 60 days after your last care ended. So if you use all of your insured days up and then you go home and get pneumonia or fall the next week (or month) you won’t be eligible for paid care again and will have to foot those costs.

Myth 6: You definitely go home after

While this is always the best case scenario, it may not be possible. Therapists, nurses and doctors will do their absolute best to get you home, but if the reality that you cannot take care of yourself becomes obvious, then you may not be able to.

Sometimes the short rehab stay is a stop along the path to long term care.

Keep in mind, that next step may be temporary as well. Some people do go to long term care for a year or so until they get all of their affairs in order and then they can return to home safely.

Myth 7: Everything will be provided for you

Unlike at the main hospital, a rehab facility does not have things like a pharmacy, cafeteria, doctors 24/7, or gift shop. Everything has to be ordered in. They do carry a limited number of generic everyday items like toothbrushes, nail clippers, shampoo and lotion.

The #1 thing you need for your stay is CLOTHING!!!!!! You will be up and active throughout your stay in all the areas of the building and probably outside of it as well. You don’t want to do all of that in a backless medical gown and non-skid socks.

Not only are they uncomfortable to wear and to be in the public in, it is also a safety hazard. Depending on the level of assistance you need, it makes it harder for the healthcare workers to help transfer or support you.

At least a weeks worth of pants, shirts, socks and undergarments and comfortable flat shoes are all you need. You’ll be moving: exercising, walking, performing daily tasks. Dresses and dress shoes (or anything with heels) are not recommended, you probably wouldn’t wear one to lift weights at a regular gym, a rehab gym is no different.

Myth 8: If you don’t like it you can switch to another facility

Unless you go back to the hospital with a medical emergency, like a heart attack or stroke, you are typically staying at the facility you choose if it’s in the same area. There are valid reasons that insurance carriers will let you transfer buildings. One is that you need to move closer to family/care coordinator/caregiver. But this is usually a self-paid move and medical transport can get pricey fast over long distances.

Then comes the hassle of medication ordering, new evals from all disciplines, all of the paperwork, etc… It is honestly a lot of work that may or may not be worth it in the end.

If you have a state funded plan, like Medicaid you may not be able to move until you get your information established and care coordinated in your new state. This could takes months, probably past the length of your stay in your current facility.

Myth 9: It’s a good time for your caregiver to go on vacation

This is actually the best time for your caregivers to get some help and education. The main load of caregiving is being done by the facility staff so this is an excellent time for a caregiver to get the therapy staff to teach them everything they need and want to know.

A lot of PT, OT, and SLP consists of educating families and caregivers on the best way to care for themselves as well.

Physical therapy can teach ways to lift, assist, transfer, strengthen and cue to reduce the risk of injury to the caregivers so they don’t end up getting injured and needing help as well. The techniques caregivers can learn for assisting can be lifechanging. Imagine learning you were doing something the hard way for years. What a relief it would be to learn a new easier method.

Occupational therapy can teach adaptive equipment techniques, fine motor needs, help find or customize tools to use at home (like weight spoons, sock aides, splints).

They can even teach caregivers how to make those things themselves.  Many times it is easier to customize a general piece of equipment than it is to find one. Ordering specialized equipment gets pricey.  (You can do sooo many things with some tape, a piece of foam and some scissors.)

Speech Therapy- It’s not just for talking! It is so much more than that. There seems to be a common misconception that Speech is extraneous. We hear in clinics all the time, “I know why she see’s you, but my mother knows how to talk already. Why does she need speech?” (Or some version of that)

Eating and drinking- anything that deals with swallowing. Thought processing- making safe decisions, ordering thoughts, communicating. Clearing spit, vocalizing, etc… Think about how important these things are to your everyday life. If you can’t form your mouth into the shapes it needs to be in to form letters, how will you articulate? If you keep choking on water every sip you take, how will you stay hydrated or prevent aspiration pneumonia? If you can’t discern between a safe and dangerous situation how will you survive? If you don’t remember how to find your way around your home, how will you live there? Caregiver training on methods to help in ALL of these situations can be vital for health, safety and comfort.

When a caregiver goes on vacation they miss out on all of these.

Myth 10: Visitors can come all the time

Ok, well technically visitors CAN come anytime the facility has visiting hours. But please don’t. I say this because the entire staff need time. Time to get everything done. 20 to 100 days really isn’t that long if you compare it to the years ahead that we preparing people for. This time is about maximizing goals, getting people to their best they can be and that can’t be done if they are busy hanging out with family or friends. There will be PLENTY of time for hanging out after discharge. In any medical facility, things are run on a tight clock. Nursing is on a medication time table that runs at least 3 times a day. CNAs are trying to answer all requests from all the patients simultaneously while trying to help with bathing, toileting and dressing. Therapy staff have to fit in 8-12 people back to back. Doctors have to do rounds and update charts. All of this happens around, food and sleep schedules. If one is off then they ALL ARE OFF.

The dreaded words all the rehab staff fears hearing “Can you come back in ten minutes?“

Myth 11: You can go out for social events

Understandably everyone wants to go to their sister’s birthday party or nephew’s graduation, etc… but the main thing to remember is… INSURANCE DOES NOT CARE!! They do not care that you love your family or want to go out.

They are looking for reasons you need to be in a rehab facility. Their reasoning =>>> If you can go out to family or social functions, in their eyes, you can go home.

Your stay at a facility is expensive for them, and they will willingly pay for it given good reason. IF you give them a reason to end it, they will do it.

Going out means you’ll miss out on your daily rehab activities. Not only does this mess up the schedule of your medical team and your treatment programming, it messes up your recovery timeline as well.

What Do I Do if I Don’t Want Therapy?

This is a tricky subject.

If you absolutely refuse to participate in therapy services and know that in the hospital, let your case manager know before you transfer!!!

This is very important. If you arrive at a rehab hospital with the facility expecting you to be an active rehab participant, then refuse to do it you won’t be getting the best care you could have.

If you have been approved for a rehab hospital and agree to go, THEN go against services, your case becomes complicated. If you go home for half a day and then realize you need to actually do rehab, you may be out of luck. You could miss out on all of the (sub-acute) therapy you could have gotten.

If you let the social worker/discharge staff know ahead of time what you really want then they can work with you to ensure you get the best care available to you at your next location. This may be home health or outpatient care. Some people just really don’t like rehab facilities. That’s OK. There is something to be said about mindset, and if your mindset would be better going to home health and you are reasonably healthy enough to go then do what is best for you.

More articles on this subject from LGM

What to Expect as a Rehab Patient at a Skilled Nursing Facility