Rehab 101

If you have already read the webpage “My Rehab Story,” then you know that over the last four years I have been in three different rehab facilities for seven rehab stays. I am not claiming this to be a good record LOL! :) I have, however, learned a few things along the way.

The rehab facilities where I was a patient were not acute care facilities. I have been in skilled nursing facilities (SNF) (sub-acute care). It is my understanding that a rehab center that is labeled “acute” offers more intensive therapy (for example, 3 hours per day as opposed to fewer hours). Acute care facilities are a very good option for people who need more intensive care.

As far as insurance goes, my best advice is to go with a Medlgap supplement rather than a Medicare Advantage plan. Even people who are healthy and don’t need rehab now are just one event (surgery, accident, stroke) away from it. Do your research, and get the best plan that you can afford. If you are like me with no viable way to switch back to a supplement from Advantage, then you must know how to deal with this. I realize that many people cannot afford supplements. I am one of them. I became eligible for Medicare before the age of 65 due to being on Social Security disability. When I checked with my state’s SHIIP (Seniors’ Health Insurance Information Program) office, I could choose from 3 supplement plans or I could go with Medicare Advantage. The plans that people can choose vary not only by state, county, and city but even by zip code! I decided on a plan F supplement, which also happened to be the least expensive supplement plan the SHIIP representative suggested. I was very pleased with this plan until a larger insurance company bought my insurance company out, and the premiums climbed dramatically. My premium plus the cost of Medicare Part B soon reached an unaffordable level. At that time I switched to Medicare Advantage. I regret now that when I turned 65 and maybe would have had more plan choices that I did not do more research to find another supplement. Perhaps I could have found a cheaper alternative.

Selecting a Facility

So if you have Advantage like me, here’s what you do. When you have a recommendation for skilled therapy and the hospital case worker hands you that list of in-network facilities you may choose from that have available beds, consider those and also find out if there are more that may not be on your list. Check with the insurance company and call facilities yourself. Read reviews on Medicare.gov and the Web. Make sure at least some of these reviews are recent. You may look at criteria such as how many therapy minutes are provided, staffing levels and response times, vaccination rates, and what percentage of people have to go to the hospital while staying in the facility, and what percentage of people are able to return back home. Also ask if private or semi-private rooms, even private baths, are available. They often are and may not cost you any extra as long as your insurance pays. They will cost more if you have to go private pay.

A New Environment

Once you have chosen and entered a facility, document, document, document. If possible, keep a daily diary in whichever manner is convenient. You may want to pack a notebook and pens for this purpose or even a digital recorder. Being in a nursing home environment can be a bit of a culture shock. You hear call bells going off at all hours. Soon enough you learn to tune them out. Sadly you may also hear someone calling out for help occasionally or groaning. A few times I have had an unexpected visitor, another patient who became confused and wandered into my room. You learn to be calm, push your button, and keep your visitor entertained while waiting for assistance.

Checking In

Do not be shocked if they do a body check on you so they can note any bruises or other abnormalities. Don’t be surprised if they want to know what belongings (including medications and valuables) that you brought with you. One facility (not my most recent one) even searched my pocketbook. This same facility also confiscated my vitamin D3 which I hadn’t really thought of as a medication. The most recent facility that I was in allowed me to take one med I brought from home. Ask the rehab’s doctor about taking any of your own medications. As part of the check-in process, you may be asked medical questions and required to take a tuberculosis test. Either at check-in and/or discharge, you may be asked screening questions for depression and cognitive impairment. A dietician or someone from the food service may consult you about your dietary needs, any food allergies and preferences. Some facilities may allow you to select from a daily food menu while others will not. If you have a visitor, some facilities may provide a free food tray for your guest. At other rehab centers there may be a small charge for the meal. You may eat in your room, or if there aren’t restrictions due to Covid, you may choose to eat in the dining room.

Laundry and Daily Life

In all the facilities that I have stayed in, none of them had phones in the individual rooms. Therefore my smart phone became my lifeline, enabling me to make and receive calls, pay bills, do needed research, and play games for relaxation. You don’t necessarily need to have a smart phone, but if there is no room phone, then you will likely need a phone of some kind. Otherwise you may be dependent on receiving calls via the front desk or the nurses’ station. If you have mobility issues, make certain you have your call bell before you are left alone. Remember that your clothing will need to be labeled. Otherwise you risk losing it. I found it helpful to bring enough comfortable clothing to use for a week. Otherwise you may end up going to the gym in a hospital gown. Actually people do that and I have done that. There is nothing wrong with a gown (or 2 gowns for your front and back). It is just not my personal preference. Some laundries will return your clean clothes within a day or two. Others have slower turn-around times, which is the reason I recommend a week’s worth of clothing. Become accustomed to the regular taking of vitals (blood pressure, temperature, oxygen saturation, heart rate). Facilities will often weigh you regularly, weekly or even daily. Sometimes the facility’s medical staff will also have lab tests done on you. The medical staff may modify your medication and/or dietary plan as a result of the lab work. For example, I was put on a protein tonic when the dietician discovered that I was low in protein. Keep all the paperwork that you are given, especially if it has to do with guidelines, finances, important health info, Covid, and/or contains signatures. Ask for a list of your medications you are being given and a schedule. I have those items, and I also ask my nurse what I am taking when he or she hands me my medicine cup. If any unfamiliar medicines show up, obviously question those. You have the right to refuse medication. Question anything that you don’t understand. I don’t care if people get annoyed with me. You have to be your own advocate. Know your rights and the policies. Know about visiting hours and visitor regulations. What precautions does the facility take in case of illness/pandemic? What about masking requirements? How many baths can you have per week? Where are these baths given and by whom? Is there a rolling bath wheelchair available? Do you need a piece of special equipment that you are not given? How does the WiFi work? Need a special password? Remember a lot of these networks are not secure so keep that in mind when going on certain sites (banking websites and email, for example). Do you need a means of locking up valuables? Some places provide one. Don’t leave valuables in plain view especially when you are asleep or are out of the room. Be aware that there are certain periods when already busy CNAs and nurses are even busier. In the facilities where I have been, these periods are often mealtimes (CNAs prepare and deliver meal trays) and either the morning getting up time or the evening going to bed time. It is probably wise (and less frustrating for everyone) to leave non-emergency requests to earlier or later times. Your caregivers make a huge difference in the quality of your life in rehab. Treat them very well. You may have a visit from an activities director. Don’t hesitate to get involved with some of the activities. Making a friend or two can really help ease the sometimes emotional rollercoaster of rehab therapy. Also check out any other amenities available. Sometimes rehab centers will have a hair salon or an outdoor area where you can go sit in the sunshine and get some fresh air.

Therapy

While in a rehab center, you may be given different kinds of therapy. I have been treated with physical, occupational, and speech therapies. Occupational (unlike its name sounds) has to do with performing the activities of daily living (bathing, dressing, toileting, and the like) rather than anything to do with jobs or career. Sometimes you will be given a therapy schedule while at other facilities you will not be. Keep a therapy log as much as possible. How many times have you had therapy and what did you do? Work hard at your therapy and don’t refuse it unless you are sick or for some other compelling reason. Just being tired doesn’t count. If something is painful or scary to you, tell your therapist. It is important to build a good relationship of trust. If you are unable to do as well in therapy as usual — maybe you are in pain — let your therapist know. Maybe he or she can note that for the record. If he or she is good, they will push you but not too far. One thing I learned while being in therapy is that a bad therapy day is often followed by a good one… so hang in there! Can you use the equipment in the facility’s gym if you are not scheduled for therapy? Is there someone manning the gym who is qualified to get you set up on this equipment?

When You Need Additional Help

If you are sick insist on seeing the facility doctor or nurse practitioner. Get familiar with the people who are in charge even if you never have to contact them. If necessary seek outside help — your primary care doctor or even dialing 911. (And yes, I have had to call 911 twice… not from my last rehab center but from another facility.)

As a patient in a rehab facility, you are assigned a social worker. Early on, ask who your assigned social worker is. Along with your therapists, a dietician, the therapy manager, this person may introduce himself or herself at the start of your stay during a meeting or evaluation. He or she may come to a later care plan meeting. If you need help, you are not getting the information or assistance that you need, reach out to them. It is why they are there.

Being Discharged

When it comes time for your discharge, make sure there’s a good plan in place, including any home equipment you need, transportation services, and home health care. The facility may hold a discharge planning meeting for you, and they may do a home visit if you want them to. Insist on a good plan. My advice is to give a lot of thought to your needs at home. I made the mistake of not requesting home health care when I should have, and I became weaker as a result. Just make sure that you will be safe at home. Be certain also when you are discharged to get all your records, including all therapy notes and assessments, nursing notes, any radiology tests, blood lab work results, doctor and specialist visit notes, in other words anything anyone wrote about you. If you end up having to fight an insurance appeal, these records will be very important.