Some
people do not need rehabilitation after a stroke because
the stroke was mild or they have fully recovered. Others
may be too disabled to participate. However, many patients
can be helped by rehabilitation. Hospital staff will
help the patient and family decide about rehabilitation
and choose the right services or program.
Hospital programs. These programs can be provided by special rehabilitation
hospitals or by rehabilitation units in acute care
hospitals. Complete rehabilitation services are
available. The patient stays in the hospital during
rehabilitation. An organized team of specially trained
professionals provides the therapy. Hospital programs
are usually more intense than other programs and
require more effort from the patient.
Nursing facility (nursing home) programs. As in hospital programs, the person stays at
the facility during rehabilitation. Nursing facility
programs are very different from each other, so
it is important to get specific information about
each one. Some provide a complete range of rehabilitation
services; others provide only limited services.
Outpatient programs. Outpatient programs allow a patient who lives
at home to get a full range of services by visiting
a hospital outpatient department, outpatient rehabilitation
facility, or day hospital program.
Home-based programs. The patient can live at home and receive rehabilitation
services from visiting professionals. An important
advantage of home programs is that patients learn
skills in the same place where they will use them.
Many stroke survivors do not need a complete range
of rehabilitation services. Instead, they may need an
individual type of service, such as regular physical
therapy or speech therapy. These services are available
from outpatient and home care programs.
Medicare and many health insurance policies will help
pay for rehabilitation. Medicare is the Federal health
insurance program for Americans 65 years of age or over
and for certain Americans with disabilities. It has
two parts: hospital insurance (known as Part A) and
supplementary medical insurance (known as Part B). Part
A helps pay for home health care, hospice care, inpatient
hospital care, and inpatient care in a skilled nursing
facility. Part B helps pay for doctors' services, outpatient
hospital services, durable medical equipment, and a
number of other medical services and supplies not covered
by Part A. Social Security Administration offices across
the country take applications for Medicare and provide
general information about the program.
In some cases, Medicare will help pay for outpatient
services from a Medicare-participating comprehensive
outpatient rehabilitation facility. Covered services
include physicians' services; physical, speech, occupational,
and respiratory therapies; counseling; and other related
services. A stroke survivor must be referred by a physician
who certifies that skilled rehabilitation services are
needed.
Medicaid is a Federal program that is operated by the
States, and each State decides who is eligible and the
scope of health services offered. Medicaid provides
health care coverage for some low-income people who
cannot afford it. This includes people who are eligible
because they are older, blind, or disabled, or certain
people in families with dependent children.
These programs have certain restrictions and limitations,
and coverage may stop as soon as the patient stops making
progress. Therefore, it is important for patients and
families to find out exactly what their insurance will
cover. The hospital's social service department can
answer questions about insurance coverage and can help
with financial planning.
The doctor and other hospital staff will provide information
and advice about rehabilitation programs, but the patient
and family make the final choice. Hospital staff know
the patient's disabilities and medical condition. They
should also be familiar with the rehabilitation programs
in the community and should be able to answer questions
about them. The patient and family may have a preference
about whether the patient lives at home or at a rehabilitation
facility. They may have reasons for preferring one program
over another. Their concerns are important and should
be discussed with hospital staff.
Does the program provide the services the patient
needs?
Does it match the patient's abilities or is it too
demanding or not demanding enough?
What kind of standing does it have in the community
for the quality of the program?
Is it certified and does its staff have good credentials?
Is it located where family members can easily visit?
Does it actively involve the patient and family
members in rehabilitation decisions?
Does it encourage family members to participate
in some rehabilitation sessions and practice with
the patient?
How well are its costs covered by insurance or Medicare?
If it is an outpatient or home program, is there
someone living at home who can provide care?
If it is an outpatient program, is transportation
available?
A person may start rehabilitation in one program and
later transfer to another. For example, some patients
who get tired quickly may start out in a less intense
rehabilitation program. After they build up their strength,
they are able to transfer to a more intense program.
Some families and patients may be disappointed if the
doctor does not recommend rehabilitation. However, a
person may be unconscious or too disabled to benefit.
For example, a person who is unable to learn may be
better helped by maintenance care at home or in a nursing
facility. A person who is, at first, too weak for rehabilitation
may benefit from a gradual recovery period at home or
in a nursing facility. This person can consider rehabilitation
at a later time. It is important to remember that:
Hospital staff are responsible for helping plan
the best way to care for the patient after discharge
from acute care. They can also provide or arrange
for needed social services and family education.
This is not the only chance to participate in rehabilitation.
People who are too disabled at first may recover enough
to enter rehabilitation later.
The information contained in this
web site is not a substitute for medical advice or treatment.
Consultation with your doctor or health care professional is recommended.
About Stroke
format.
Some
people do not need rehabilitation after a stroke because
the stroke was mild or they have fully recovered. Others
may be too disabled to participate. However, many patients
can be helped by rehabilitation. Hospital staff will
help the patient and family decide about rehabilitation
and choose the right services or program.
