Help me understand rehab vs. SNF?

All rehabilitation facilities in our area are also classified as SNF's.

SNF's often have rehab units vs long term custodial care.......physical and occupational therapy for instance........... unfortunately my mom was not an appropriate candidate for rehab, as she had dementia and was bedridden and incontinent......rehab wasn't going to be able to help a 94 year old woman in that condition, but the SNF gets a lot of money from medicare for this, up through day 100......I wanted her out earlier but it was the height of the pandemic and I couldn't get in.......when insurance ran out they were quick to release her

graygrammie: My mother was in the rehab unit OF a skilled nursing facility.

I'm glad that you are working with the case manager to get your BIL the needed rehab. It does appear like he is improving by leaps and bounds. Good for him!

You need to be talking to his doctor. Some SNF have Rehab section. His Medicare will help with rehab therapies to continue building his strength. While he's still at VA, talk to social worker to explain you want to continue building his strength. They may already be setting up rehab via SNF. If not, his other doctors who saw him pre-covid illness can probably help you.

snf has rehabs, most of them or all of them are not separate,he goes to it just in case the transition needs to be permanent in which medicare only pays for 3 months,

When my mom had her stroke and wasn’t able to speak anything coherent (aphasia) we were told that there are basically two levels of rehab (at least in her area) acute rehab where she would get PT, OT and ST every day or basic rehab where she would get those things as well but not everyday. Her physical deficits were improving so rapidly however that she wouldn’t qualify for acute rehab much longer (insurance qualifications) so if we wanted that we needed to make a decision within 24 hrs. That’s what we wanted so that’s what we did but because her physical deficits were improving so rapidly she didn’t qualify to stay in acute rehab for as long as she needed the more intense Speech therapy even with them trying to keep her there, she was making progress by leaps and bounds in her speech and cognitive thinking. She wasn’t ready to stop speech therapy so our choices were the stepped down therapy in a SNF or taking her home with out patient therapy, she still couldn’t be left alone much and needed someone with her however so if we weren’t going to SNF we would need to provide that. She would get speech therapy once or twice a week as it isn’t considered important enough to be a stand alone need in rehab by Medicare and we had no choice in therapists so we decided to take her home, it was the rite decision for us. She wasn’t recovering from a vent and feeding tube though and was mobile on her own able to do her ADL’s on her own. It may be that a) the VA only helps cover SNF and that they have a better SNF set up when it comes to PT if they are encouraging their own SNF. It also may be that he needs more nursing still that acute rehab is set up for and the rehab in the SNF is equipped to provide what he really needs of both. SNF doesn’t always mean LTC and I think we often think of it that way but there needs to be a place for paitents who’s road to recovery may be longer, they are no longer in an acute phase of their illness needing the highest level of care at least readily available but still need hospital type care and will for a while until they recover to the point of being able to go home or have no more improvement for a length of time that makes them a candidate for LTC. It’s like the difference between the ICU then specialized floor or generalized floor in the hospital, for some a specialized floor is necessary for others a generalized floor is best. Yes a patient going to a SNF for rehab may not progress to home in which case they need LTC and ideally they can move to that within the same facility.

I would gather all the real opinions and why you can, ask the VA why they are leaning so heavily on the side of SNF or that particular facility if it’s a specific one they seem to be pushing. Ask the discharge coordinator at the hospital what the differences are, what are the doctors recommending? What are the choices and what do the people you trust the most recommend, visit them if you can and make the decision you feel best about. There are so many things to consider and the more information you have the better you will feel about it all, you don’t have to simply take what is easiest for the discharge coordinator or the VA you have some say here, you are wise to question here and make it an informed one.

Do you have a continuing care retirement community (CCRC) near you? If so you or the hospital social worker might want to check if they have a bed and will accept your bil.These places are very expensive to buy into but they accept short term Medicare patients for rehabilitatio. After her operation my wife was in the Acts/Evergreens for 60 days of recovery and rehab. I can’t say enough good about the Evergreens. She had a private room, individual control of the thermostat, gourmet meals but most importantly the PTs and OTs, nurses and aides were all very good and very friendly. We have straight Medicare with a supplement which paid for the entire stay.

The SNF should provide both
" rehab" and any ongoing support needs ( such as toileting assist that you mentioned). Talk with his PCP and Case Manager ( usually a Licensed Social Worker or RN) to be clear on the POC ( Plan of Care) going forward to include " rehab" ....

SNF may sound more ominous than it is.....stay in communication with the care planning staff when he gets to the SNF......

Practice good self care.....

a SNF is a rehab - the differance is in rehab you stay 3 months or less but SNF you stay long term but its the same facility - usually they have the long term residents on another floor .....he will still get rehab in SNF, no? You can keep him there until he is stable and strong and then bring him home?

My mother went to one rehab (very fancy!), but since she kept making things difficult by calling me and telling me they were trying to kill her, I had her transferred to a SNF that also had rehab (suspecting she would need SNF placement after rehab, since she declined so much after her hospitalization for a gallbladder infection). Once her rehab time was up, there she already was in the SNF -- same room, even.

On a side note, I'm so sorry your BIL got covid after taking the precaution of wearing an N95 mask. Did it have ear loops? Those do not have as good of a seal, usually. How awful of the restaurant to suddenly refuse to bring the food to your bil's car.

This is an example of many, many things I will no longer do (go where there are crowds), because I do not want to get covid. That includes things that could benefit other people, like donating blood (we have 0+ and the very valuable O- in my household). While I would be masked, I couldn't stand people near me for that long of a time who are not masked. Also why I no longer will volunteer in the schools like I did, or in a community action group. I don't feel very altruistic anymore.

A few weeks ago I had to pitch a fit, because the HCWs doing my colonoscopy were not going to mask. I had called when making the appointment, and I was assured that they would be masked. Then I was told that the CDC doesn't require it, and that they would "review the telephone tapes." The HCWs DID end up masking, but you can be assured I won't be going back there.

I know people on this forum don't believe in covid, don't believe in masks, don't believe in covid vaccinations, etc. I am not one of them!

Without reading all the comments.... when my husband at 55 (with Parkinson's) fell and broke his hip, I knew I could not care for him alone during his total recovery so the doctor agreed for rehab. The social worker suggested several SNF and I knew he did not need that so I opted for the only rehab nearby. For us, it was the worst choice at the time because he also needed quality nursing care. I was not told at the time that many SNF also does rehab! I too thought an SNF would be writing him off to die. Many SNF provide excellent PT, OT, Speech and Swallowing rehabs so definitely ask them what they mean by SNF. Go and visit the SNF they would be sending him to and you may be surprised at the care he may get and it could be the same or even better because they may provide better nursing care.

My husband had a near fatal stroke in November 2011. Spent a couple of weeks in the ICU in our City's trauma teaching hospital, then referred to a rehab facility 20 miles away from our home. The discharge to the rehab facility happened during the week between Christmas and New Year and the medical coverage was slim to none. The covering doctor told me, before my husband was even evaluated, that the plan was to treat and ship out to SNF or palliative care in a two week window. Husband had a tracheostomy when he arrived there and this facility was supposed to be able to address respiratory issues, but they didn't. All I got from the staff was, 'he has secretions'. That's not an acceptable answer. The only good thing that happened from this encounter was the referral to a skilled nursing facility that spent months bringing him back in terms of cognitive and motor abilities until he was safe to return home. We private-paid. Beware of 'rehab' facilities and don't believe everything they publish in the slick brochures showing patients learning how to walk again. Even when you bring in a medical advocate to help you fight for the treatment that's written on the patient's whiteboard, your calls for help get ignored while they draw on your health insurance.

Not sure which best applies to your question. My husband and I are both veterans in our late 80's and early 90's. When the VA cannot provide what you need medically, they have a program called Community Care. You have to be approved for it through (most likely) your PCP, or specialist in charge of the type of care needed. This pays 100% of the costs. We have both used this program successfully. My husband has used it for severe eye issues, and knee replacement surgery. I have used it for Cardiac Care - several times.

On the other hand, SNF has been used by our sister (88) with equal success. Her medical coverage paid for the entire bill. She has been in the SNF twice during the past 5 years. I don't know if you are permitted to choose the SNF of you choice or not. I am pretty sure that we were given a list from which to choose the one we wanted.

The SNF way is most likely under the Community Care banner for the VA. So, you would have to go through an approval process.

I would recommend that you ask for the names of the SNF's available in your location - then visit them for your own assessment of their quality. If you find what you consider to be glaring deficiencies in the NSF's on the VA's approved list, you can document the deficiencies and request that you want/need a different facility and why you find it better for you. With good documentation you should be able to find the best one for you.

A starting point might be a visit to your VA to speak with a patient ombudsman. they are, in my experience, very knowledgeable and extremely helpful. While you are sitting there, they make calls on your behalf that can lead to your desired care.

I hope that I have been able to help you decide what to do that suits you best.

As I said, we have used both types of care and been pleased with both.

Every skilled nursing facility (SNF) where I worked had a rehab unit where the patient is taken for rehab. In an event that causes decline in a patient an assessment is done and the physician will order rehab. It may be speech therapy to improve swallowing or physical therapy to improve mobility or occupational therapy to restore certain aspects of self care. SNF is longterm care rehab is not, usually the length of rehab is determined by the patient's progress.

I wanted to update with new info.

My sister said their other insurance (not VA) has approved her husband for a number of facilities of her choosing. All that she needs now is an open bed at one of these facilities.

Yes I believe most rehabs are contained within snf's. My mom's doc wanted her to go to an acute care hospital on intravenous nutrition (tpn) when she lost her swallow ability post spine surgery.

She and our family decided to have a feeding tube placed instead and sent to rehab after already having spent a month in the hospital on the TPN, she was 108 lbs! He said "oh so a nursing home", and I honestly think he said this to scare her because we went against his plan and he thinks he's God. Makes my blood boil thinking about it.

The good news is while the rehab wasn't great, (they kept saying oh people on tubes usually move to the third floor, meaning the actual nursing home floor! Like it was a certainty. And we were like yah, no) she is now weaning off the feeding tube! I wish the best for your BIL.

My mom was given a choice as to where she could attend rehabilitation after a series of falls.

We could have gone with assisted living facilities that offered rehab services or skilled nursing facilities that had rehab.

There were no separate places that had rehab centers.

We went with a skilled nursing facility. Mom had a very sweet woman as a roommate. She enjoyed her company. This woman was not doing well and her daughter ended up placing her in the residential part of the facility. Rehab had done all that they could for her and it wasn’t successful for her.

So, I suppose that is one advantage of being in a skilled nursing facility. Her mother would not have been a candidate for an assisted living facility.

I thought that it was great that the hospital where mom was actually started doing PT with her before she left to go to the rehab program. She went straight from the hospital to rehab. They provided her transportation. I was instructed to go ahead of my mother in order to fill out her paperwork.

@AlvaDeer -- Correction, "my sister has NOT been bedside for twenty years."

I believe there are very few freestanding facilities that are only for rehab except for some that are acute rehab hospitals for people needing much closer medical monitoring. Acute rehab is also often done in designated wards or sections within hospitals, as appears to have been the case here. SNF (skilled nursing facilities), as others here have noted, usually also do short term rehab. covered by Medicare or other insurance. So I think moving to a SNF to get additional rehab is just another step in the recovery process. I would assume the VA is not pushing SNF vs rehab, but rather that it's been determined that the next step in his rehab process will be in a SNF instead of an acute rehab facility. Here's an example from the parent of one of my neighbors who recently had a not too severe stroke. First step was hospital (obviously), where they were monitored and evaluated for a few days; although recovery was proceeding OK and they were ready for rehab, blood pressure was still unstable and they had some other underlying medical conditions that needed close monitoring, so the next step was an acute rehab hospital where they got more evaluation and had PT, OT, and speech therapy. After a week or so there, they were ready to get transferred to a SNF where they received yet more PT and OT until they were able to regain enough independence to be able to transfer to an assisted living facility.

Well, my GUESS is, graygrammie, that the SNF is still considered a requirement due to some healing issues status/post trach and etc. He is likely still considered medically fragile.

I would check and ask about this SNF in terms of their rehab, PT, OT regimine, as they vary a whole lot. Some have quite a lot of rehab and some almost none at all.

With this level of improvement I think it is very unlikely that they are "giving up on him". He appears to be getting so much better in leaps and bounds.

I am assuming you have asked this question of the "powers that be" here? And what have they said to you?

He truly is moving forward from a near death to recovery, and like you I hope he gets wonderful support. I couldn't wish him more luck. I am so glad there is motivated family looking in here, because in this case it may make all the difference.

I hope you'll keep updating us here.

Thanks for the feedback. I will bring it up with my sister the next time there is discussion. Nothing was discussed at the hospital today.

He probably being transferred to a SNF that also has a Rehab wing. Thats how its done in my area. Medicare will pay 100% the first 20 days, then 50% for 21 to 100 days. Your BIL will be required to pay the other 50% or his supplemental will cover it. The amount of days he is required to stay will be based on his progress. He will be asked to sign admitting paperwork and sign that he understands what he will be paying out of pocket.

They can be the same thing. My mom was in a SNF where some lived there full-time, and they also rotated lots of rehab cases through as well.

In my area rehab units are all within nursing homes, they are not separate facilities. Rehab is usually a separate area from the long term care.

Ask if they are recommending acute or subacute rehab at the SNF; perhaps the "hospital within the hospital" was acute rehab, and now they are recommending sub-acute?

Or are they recommending long term custodial care.

That is the differentiation she needs to ask about. It's the SERVICE she needs to ask about, not what facility it happens in.

I have a friend who recently had a horrific fall and brain bleed. The hospital recommended subacute rehab. She and her husband fought like tigers to get her to acute rehab at Rusk-NYU where she made a complete recovery. Support from her neurosurgeon helped.

Clarify what's being recommended.

Also, if they are recommending ltc WITHOUT rehab, ask for (i.e., demand) a care meeting with the rehab team and go over their assessment of BIL's current condition and progress. Is it an accurate assessment? Or is it based on a previous assessment?

Don't be shy about ringing up the office of his local elected officials and getting support from the person who advocates for Vets and elders.