You’ve successfully gotten your spouse through their surgery and have helped them make the transition to an inpatient post-hospital rehabilitation center for their recovery. Do you know what’s coming next?

Here’s what you can expect during their stay at the rehab center and the transition home, as well as tips and advice to make the most out of the process.

How to Support Your Spouse

What to Pack

When your spouse first makes the transition from a hospital to a post-hospital rehabilitation center, it’s important to pack comfortable clothes and sturdy shoes that they can wear during physical or occupational therapy sessions.

As you pack for a rehab center stay, you’ll also want to bring things such as:

• Personal care items and toiletries
• Comfortable pajamas
• Exercise clothing
• Family photos or keepsakes to personalize their room
• Chargers for cell phones and tablets
• Books, puzzles and other entertainment items

Most rehab centers will have fully furnished rooms, so you don’t need to worry about packing blankets or pillows. However, if they would prefer to use their own, patients are welcome to.

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Related: Ask the Expert: Types of Post-Hospital Therapy for Seniors

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Realistic Expectations for Rehab

For many patients and their spouses, inpatient rehab is an entirely new experience. If your spouse has never had major surgery before or is unfamiliar with the rehab process, it can be intimidating and, at times, frustrating.

That’s why it’s so important to keep realistic expectations for rehab. For example, if your spouse is eager to be home and expects to be out of rehab in a few days, you’ll want to keep that expectation in check. The average length of stay in rehab is 12.4 days, but a lot of different factors can affect that, including age, severity of condition and motivation to complete therapy.

It can also help put both your mind and your spouse’s mind at ease if you know what to expect from the process as a whole. Everyone’s experience is different due to individualized therapy plans, but here’s the basic outline of what to expect from a stay in post-hospital rehabilitation:

• The patient is admitted from the hospital.
• The therapy center conducts an assessment of the patient’s condition and creates a personal care plan that includes diet, medication and physical, occupational and/or speech therapy.
• A care conference is held with the person receiving care, their loved ones and care team members. During the conference, you’ll go over the therapy schedule and start discussing discharge plans.
• The patient completes therapy according to their therapy plan. The amount and frequency depend on their needs, but typically they will receive therapy about five days a week with about one hour each day for each necessary discipline (physical, occupational and speech therapy).
• When the patient is ready to be discharged, staff will work with the patient and their loved ones to prepare a discharge plan. The discharge may include additional outpatient therapy.

Understanding Your Role as a Family Caregiver

During the rehab process and care conferences, you play a vital role as the loved one of your spouse. You may not realize it, but you have something very valuable to contribute to the care team.

You know your loved one better than anyone. You alone can provide the care team with information they need about your spouse’s personality, including what motivates them and how they prefer to communicate.

Next Step In Care is an excellent resource for family caregivers. They offer these insights for caregiver contributions during the rehab process:

• Patient motivation. Does your loved one respond well to a challenge, or would they prefer not to be pressured? Do they need a lot of praise to motivate them? Talk to the rehab staff so they know what works best.
• Relationships with therapists. Everyone’s personality is different. Clue your spouse’s therapists in on any personality traits that may affect their rehab and that can be incorporated into their treatment plan.
• Feelings. If you feel like your spouse is feeling frustrated, tired, discouraged, overwhelmed, etc. during the rehab process, have a conversation with the staff.

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Related: Ask the Expert: What Are Some Examples of Therapy Exercises?

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Supporting Your Spouse During the Transition Home

Discharge Planning

The good news is, you don’t need to worry about planning for your spouse’s discharge. The staff at the rehab center will work with you and your spouse to create a discharge plan. That plan will take into account things such as the transition home, necessary equipment and any follow-up care or rehab.

During the discharge planning, it’s important to be open and honest with the care team about your limitations. For example, if you work outside the home and will have limited time to devote to being a caregiver for your spouse, you’ll need to let the team know that so they can provide the best recommendations for your situation.

As the experts at Family Caregiver Alliance point out, “the discharge staff will not be familiar with all aspects of your relativeʼs situation. As caregiver, you are the ‘expert’ in your loved oneʼs history. While you may not be a medical expert, if youʼve been a caregiver for a long time, you certainly know a lot about the patient and about your own abilities to provide care and a safe home setting.”

Managing Stress

Surgery and rehab can be stressful on both the patient and their loved ones—especially if it was an emergency surgery. It can take a toll on both your relationship as spouses and on your mental health as a caregiver.

Psychiatrist and caregiver health researcher Peter Rabins, M.D., M.P.H., co-director of the geriatric psychiatry and neuropsychiatry division at The Johns Hopkins Hospital, recommends these strategies for caring for a spouse during a health challenge:

• Listen and share. Let your spouse talk about their concerns and share your own. Spend time together as you used to whenever possible, whether that be taking an evening walk or enjoying a quiet breakfast together.
• Stay informed. “The more you know, the better,” Rabins says. “It’s OK to start with the Internet, but make sure you find reliable websites that provide accurate, up-to-date medical information. Be sure to ask health care providers questions too.” He also recommends you talk to doctors together so you’re both on the same page.
• Avoid “nagging.” As a caregiver, you’ll likely be helping your spouse with things like diet, exercise and medication. However, sometimes it can feel like nagging. Rabins suggests you ascribe directions to their healthcare providers. He writes, “instead of saying to your partner, ‘You must take all of your pills,’ you can say, ‘I asked the doctor and she said it’s most important to take these medications on a strict schedule, but it’s OK to take this one a little later.’”

Finally, one of the most important things you can do as your spouse’s caretaker is to take care of your own emotional and physical health. Accept help when it’s offered and take time to recharge your batteries.

Everyone who receives services from an inpatient rehabilitation center leaves with a discharge plan in place that outlines any necessary follow-up care. This plan often includes therapy exercises to be completed at home.

It might be tempting to ease up on your exercises and go back to your normal routine once you’re back in the comfort of your own home. However, it’s very important to continue with your therapy plan post-discharge.

Physical Therapy after Inpatient Rehabilitation: Why It Matters

Continuing with your physical (or occupational) therapy plan once you return home is vital to your recovery process.

When people do not follow their care plan, it is not uncommon for them to be rehospitalized after a few weeks at home. In fact, according to the American Physical Therapy Association (APTA), nearly 1 in 5 Medicare patients—2.6 million senior citizens—discharged from hospitals are readmitted within 30 days.

Continuing therapy at home can reduce your risk of rehospitalization. As Eric Ries writes in an article for PT in Motion, a publication of APTA, a study found that “‘a patient was more likely to be readmitted when the therapist discharge recommendation was not implemented and services were lacking,’ compared with instances in which [physical therapist]-recommended steps were taken.”

Continuing Therapy at Home: What to Expect

According to Next Step In Care, a helpful online resource for caregivers, there are four typical situations patients find themselves in after leaving inpatient therapy:

1. Home, with no needed services.
2. Home, with help from a family caregiver.
3. Home, with help from a home health care service provider.
4. A long-term care setting (such as an assisted living community).

If heading home is part of your discharge plan (which is something that you and your care team will discuss together before leaving the rehab center), you might be wondering what sorts of therapy you’ll be asked to complete on your own.

Below, we’ll go over a few examples of what to expect when you return home, either with help from a family member or a home health professional.

Continuing Physical Therapy at Home with a Family Caregiver

When returning home from inpatient therapy with help from a family caregiver, you will have any necessary rehabilitation outlined in your discharge plan.

If a friend or family member will be helping you at home, it’s a good idea to have these questions answered before you leave the rehab center:

1. How long does it typically take to recover from this type of illness or procedure?
2. What restrictions will you have and how long will those be in place?
3. Will any additional physical, speech or occupational therapy be required? If yes, can it be arranged through home health care, or with an outpatient facility?
4. If you live alone, will you need additional safety precautions or durable medical equipment? Are you mobile? Will you be able to care for your own physical needs including bathing, dressing and meal preparation?
5. How will you get to appointments, therapy, pharmacy and grocery store?
6. Will your medications interfere with activities of daily living (make you dizzy or tired)?

It’s likely that many of these questions will have already been addressed by your care team. However, if they have not, feel free to ask. Everyone’s goal is to keep you healthy and safe as you transition home after a rehab stay.

Continuing Physical Therapy at Home with a Home Health Care Provider

Home health care is another option you have after completing inpatient rehab. A home health care professional can help you continue your therapy plan, as well as provide other supportive services such as expert advice for making your home a safer environment.

“When someone discharges from here, I frequently recommend home health therapy. They need to be acclimated to their home because often they haven’t been there in months,” New Albany Rehabilitation Center Rehabilitation Manager Jeremy Evans, PTA, LMT, says. “The home health therapist can point out problem areas, such as loose rugs or no grab bars, and help them practice with things in the home. For example, the stairs may be different at home than the ones they practiced on at the rehab center.”

Home health therapists can also show you how best to exercise at home, where you won’t have access to the same equipment as you did at the rehabilitation center.

“The home health therapist can give you home exercise ideas,” Evans explains. “For example, you might not have exercise equipment at home like we do at our MacIntosh rehab centers, but they can show you easy substitutes like milk jugs filled with water for strengthening exercises.”

Meet Your Goals During and After Inpatient Rehab

As part of your rehab plan, most centers will work with you to set goals for your recovery. These goals help you stay motivated and provide benchmarks for your recovery journey.

When you return home, following your therapy plan will help you continue to meet those goals. More importantly, it will help reduce your risk of returning to the hospital or experiencing a decline in your health.

Dear Kelly,

About a week ago, my 74-year-old mom had a stroke. None of us were prepared for something like this, and now we’re scrambling to take care of her as best we can.

The stroke wasn’t a severe one and she’s doing well, but she is having some speech issues and difficulty balancing. Her doctor said she’ll need rehabilitation after her hospital stay and recommended that she complete physical, occupational and speech therapy.

What do all those entail? Do my brothers and I need to track down three different therapy places for Mom? Any chance you could help clear this up for us?

Sincerely,

Dave Z.

Columbus, OH

 

Dear Dave,

I’m glad to hear that your mother’s stroke wasn’t severe, but it sounds like there’s some work to be done moving forward.

Toward that end, here’s what you should know about post-hospital rehab for senior patients and the types of therapy available.

Types of Therapy for Seniors After a Long Hospital Stay

If a senior patient needs a little help getting back on their feet after a stay in the hospital, their doctor may recommend that they seek therapy services (also known as rehabilitation).

There are different types of rehabilitation and therapies available, which is what you were asking about. Let’s go over those three therapy types you mentioned and what they include.

1. Physical Therapy for Seniors

According to the American Physical Therapy Association, physical therapy “can help restore older patients to their highest level of functioning possible.”

Note that it’s the highest “possible” level of function—depending on what was affected during your mother’s stroke, she may not be able to recover to her former level of physical health. However, physical therapy can help her reach her new optimal level.

Physical therapy may include therapeutic exercises such as practice walking aided or unaided, stretches or balance training. A physical therapist will work with your mom to discover where her problem areas are, then create a rehab plan based on their assessment.

2. Occupational Therapy for Seniors

If a senior suffers a health setback, it may be difficult for them to do the everyday things they used to do, like open bottom dresser drawers, get in and out of the bath, put laundry in the washer, cook on a stove and so on.

That’s where occupational therapy comes in. It’s designed to help improve your mom’s ability to live independently and focuses on bathing, dressing and grooming tasks.

As with physical therapy, it’s tailored to each patient’s needs. So if there’s a certain area your mother is struggling in, a professional therapist will be able to help her with it.

3. Speech Therapy for Seniors

It’s not uncommon for seniors who have suffered a stroke to struggle with speech. Speech therapy can help improve a person’s ability to communicate, as well as help with swallowing if that’s an issue.

Where to Find Therapy

Now, to answer your question about whether your mom will have to go to three different places to receive the three different types of therapy, it depends on the rehab facility you choose. It’s likely that the facility will offer all three, but it’s also possible that they won’t specialize in all of the areas your mother needs.

One senior rehab option available to people like your mother is a post-hospital rehab community. Post-hospital rehab communities provide different types of therapy for seniors, as well as a variety of services and amenities.

For example, all seven of our MacIntosh communities in and around Columbus, Ohio offer rehab services, including physical, occupational and speech therapy. Because every person who comes in the door is different from the last, each patient receives a personalized plan of care based on their personal goals and level of function.

As you begin your search, I recommend taking advantage of these free resources:

Why Discharge Rate Matters When Choosing a Rehab Center

Ask the Expert: Post-Hospital Rehab Insurance Questions

Please let me know if you have any other questions. I hope your mom has a smooth recovery!

Best,

Kelly Braden, PT

Rehab Manager at West Park Rehabilitation Center

You’re about to leave the hospital, headed for a post-hospital rehab facility as the next step in your recovery. Your doctor has signed off on your release, the flowers and cards from well wishers are all packed up and you’re ready to go. But you may be feeling nervous or even overwhelmed—how do you know what to expect during your first 48 hours in inpatient rehabilitation?

Don’t worry—there will be someone with you every step of the way to walk you through the process. But here’s an outline of what you can expect during your first 48 hours and beyond.

When you first enter your room, you’ll have some time to settle in and familiarize yourself with your accommodations. If you’d like, you’ll also have time for a bath or shower.

A nurse and nursing assistant will visit with you to go over any immediate questions you have and to acquaint you with the care community. From there, the process is as follows.

Day One

Clinical Assessment

Your nurse will review the information we’ve received from the hospital or your physician with you and complete a clinical assessment.

You can expect the clinical assessment to take a while because you’ll be going over all of your medical paperwork, taking care of initial goal setting and completing a medication reconciliation to make sure that all of your medications (both from the hospital and from home) are accounted for, among other things. This is also the perfect time to talk about what’s important to you during your stay.

Admissions Paperwork

As part of the admissions process, admission paperwork will be completed with one of our admission staff members. We’ll help you take care of all the necessary paperwork and review your financials with you.

Dining Services

From day one, you’ll be able to enjoy delicious, chef-prepared meals, showcasing two specials daily and a Bistro Menu. You’ll also receive a visit from a dining service representative. They’ll ask you about your likes, your dislikes and any allergies you may have. If necessary, they’ll review any specialty diets as recommended by the hospital to ensure you’re receiving the proper nutritional support.

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Related: Ask the Expert: How’s the Food in Rehab?

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Social Services

Your social worker will start the conversation about your discharge with you on day one. Their focus is to provide proactive care coordination and discharge planning based on your personal needs and desires.

They’ll ask you questions such as:

• What are your plans for returning home?
• What does that home set up look like?
• What support systems do you have in place?
• What barriers do you see for going home?

That way, they’ll be able to spot any areas of concern and create a personalized discharge plan to help you get home as safely and as quickly as possible if that’s your goal.

Day Two and Beyond

Therapy Evaluation

An initial therapy evaluation will be completed, usually on the day following your admission to determine your current level of function. Your therapist will work with you to set personalized goals and will create a plan to obtain a positive therapy outcome.

You’ll most likely be assessed by a minimum of two therapists, as you’ll be seen by a therapist from each therapy discipline that you need. The three therapy disciplines are:

• Physical
• Occupational
• Speech

Interdisciplinary Care Conference

To make sure your family is kept in the loop, a patient and family care conference will be scheduled with our interdisciplinary team members to discuss your personal plan of care.

Setting You Up for a Successful Inpatient Rehabilitation Stay

As you can see, you’ll have plenty to keep you busy during your first few days in rehab. After your first two days, you’ll be able to settle into a comfortable routine of therapy, dining, activities, socializing and whatever else you’d like to do during your stay.

Keep in mind, the process outlined above may not necessarily happen in the order listed and some things may wait until day two of your stay. Many people don’t come to our care communities until later in the day and we don’t wish to overwhelm new patients with too many visits.

The goal of everything we do on your first two days is to get to know you. We want to see you as more than just what’s on your chart—we want to know your likes, dislikes, goals, concerns and more. It’s all about starting to paint the big picture so we can provide the kind of personalized, patient-directed healthcare we’re known for.

If you would like to learn more about our therapy services, please contact us or schedule a tour.

My father’s physician is recommending a short-term rehab after Dad leaves the hospital. I’m not exactly sure what that entails, and, to be honest, it sounds a little scary! Can you help me understand what I need to know?

-Evelyn in Columbus, OH

Hi Evelyn,

Many central Ohio older adults (or their family members) may not understand the role a rehab center can play in their recovery. The underlying fear for some people is that once they are admitted to a rehab center, they won’t be going home again. In today’s healthcare environment, hospital stays are getting shorter and shorter. Skilled nursing and rehab centers are being used as a transitional step on the journey back home.

Here is what you should know about today’s short-term rehab centers:

• Your dad will more than likely be surrounded by older adults who are in situations similar to his. They may have undergone a surgery or are recovering from an illness or injury. Each of them has the goal of successfully recovering and returning home.
• Taking advantage of the Medicare Skilled Nursing & Rehab benefit allows seniors to get back on their feet in a safe, supportive environment. That increases the chance for your father to return home to an active and independent lifestyle.
• Your father has choices. You and your father can decide which short-term rehab center best meets his needs. The only limitations might be whether or not the center takes his type of insurance and if they have a room available when it is time for him to be discharged from the hospital.
• Short-term rehab centers have interdisciplinary teams made up of physicians, nurses, therapists and other healthcare professionals. Together, they will develop a plan of care for your dad and meet at least weekly to discuss his progress and make any necessary adjustments to his care plan.
• Unlike the hospital setting, he won’t be confined to his room while he is working on his recovery. Rehab centers have a variety of programs that take place each day that he can participate in. Some may even include outings to local restaurants and movie theatres.
• While he is staying in a short-term rehab center, he will be considered a patient, not a resident. That means everyone there understands the goal is for him to rehab and return home.
• Short-term rehab centers focus on individual goals and progress. Your father will be encouraged not to compare his diagnosis and recovery to anyone else’s. No one’s recovery is the same.
• The staff welcomes and encourages questions and concerns that you and your father may have. They understand that communication is an important part of staying motivated and feeling positive about  recovery.

Evelyn, I hope this information gives you peace of mind in understanding what comes next on your father’s road to recovery. If you have any other questions, please feel free to give me a call at 614.875.7700.

-Stefanie Hayes, LNHA, Administrator