After a stroke, a broken hip or major surgery, even getting dressed or walking across a room can take weeks of practice. For families leaving the hospital, the next question is where that work should happen: in an intensive rehabilitation center, a skilled nursing facility or at home.
The choice can shape how much medical support and therapy a patient receives each day. Kerri Fitzgerald, executive director of the Hackensack Meridian Johnson Rehabilitation Institute at Ocean University Medical Center in Brick, New Jersey, says families should make the decision with the health care team. The team can assess the patient and recommend inpatient care or outpatient therapy at home or another location. Whatever the setting, the plan should fit the patient’s health needs, and the place should be safe, easy to navigate and welcoming to family visits.
Inpatient rehabilitation is generally the most intensive option. It is designed for people who still need regular medical care as they work toward returning home. At least three hours of therapy a day, five or more days a week, is typical. Physical, occupational and speech therapy may be part of the program. Occupational therapy helps with daily tasks such as bathing and dressing, and sessions are almost always one-on-one, according to David Michael, an occupational therapist at Brown University Health’s Newport Hospital in Rhode Island.
A doctor checks on patients daily, and the care team meets each week to adjust the plan. Fitzgerald recommends asking whether the team includes rehabilitation-trained nurses, therapists, dietitians and social workers. Families can also check what equipment is available, whether the center is connected to a hospital for round-the-clock emergency care, and whether it can meet the patient’s cultural and personal needs.
Skilled nursing facilities offer less therapy, usually one to two hours a day about five days a week. Some sessions may be in groups, and doctors may visit only weekly. These facilities do provide steady nursing help, including support with movement and personal care, as well as medication, wound and IV-line management. But a sudden medical issue may require a trip to the emergency room and another hospital stay.
Home health care can mean greater comfort, but less frequent professional support. A therapist may visit only a couple of times a week, and appointments can shift. Home recovery is best suited to people who can move around safely, including on stairs, manage basic self-care and use needed equipment such as a shower chair. If they cannot, they need someone with them at all times, such as a relative or paid caregiver. Family members may take on medications and wound care, while a nurse may visit about once a week.
People who can travel may also go to an outpatient clinic for therapy. Before choosing one, families can ask how often sessions happen, whether they are individual or group-based, and whether the clinic offers follow-up sessions, balance or vision and thinking therapies, and a home exercise plan.
There is no single best setting for everyone. Matching the level of therapy and medical help to what a patient can safely manage can give recovery a stronger start—and help families know what support they will need after the hospital doors close.