ere are words you are unlikely to ever hear
from a stroke survivor: “I had too much
rehab.” Quality rehab is something nearly all
stroke survivors are extremely interested in.
That is because, as one of the first survivors
we interviewed for Stroke Connection said,
“Rehab is life.”
Because the time and money spent on
formal rehab are precious, selecting the right facility is
essential. In this, the first part of a two-part series on stroke
rehab, we hope to help support the decision-making process
required when it’s time to leave the hospital.
Selecting the Right Rehabilitation Facility
Having a stroke can be an overwhelming event —
certainly life changing. But the type of rehabilitation
and support systems a survivor receives at discharge can
strongly influence health outcomes and recovery. With that
in mind last year, stroke experts from the American Stroke
Association published its first-ever Guidelines for Stroke
Rehabilitation and Recovery for Adults.
“There is increasing evidence that rehabilitation can have
a big impact on the survivors’ quality of life, so the time
is right to review the evidence in this complex field and
highlight effective and important aspects of rehabilitation,”
said Carolee J. Winstein, Ph.D., P. T., lead author of the
scientific statement published in the May 2016 issue of the
American Heart Association journal Stroke.
Stroke affects so many different functions — paralysis
and weakness; gross motor skills; fine motor skills;
speech and language; cognition; vision; and emotions —
stroke rehab typically involves healthcare professionals
from several disciplines — occupational, physical and
speech therapists, physiatrist, dietitian, social worker and
The average hospital stay in acute care for stroke
patients is between four days (ischemic) and seven days
Time is a consideration at this point for two reasons.
First, since survivors are typically discharged within a week,
there is a need to quickly find a facility for the survivor to
go for continued care. Second, the brain seems most able
to improve in the first months after the stroke, so getting
survivors into rehab quickly allows them to take advantage
of that recovery window.
The difference between IRF and SNF
In IRFs, there is typically a team approach to
rehabilitation, and all the therapists meet and discuss
the people in their care and their treatment plans. This
approach, Winstein suggests, needs to be one of the first
questions a family should ask when evaluating any facility.
Here are some things to keep in mind as you are
planning for discharge from the hospital:
• Not all types of facilities are available everywhere;
so depending on where you live, you may have lots
of choices, few choices or no choice at all without
travelling some distance.
• Insurance may limit what facilities are available, e.g.
a specific facility may not be “in-network” on your
• If there are multiple options in your area, ask the
healthcare team for a recommendation.
• Find out more about any recommended facility. Check
it out on the Medicare or CARF websites that share
quality rating and accreditation information (see
Comparing Facilities, pages 12-13). Talk with staff of
the facility and take a tour.
• Use the American Heart Association’s free Making
Rehabilitation Decisions PDF for information and
checklists that can support you in making the best
decision about your next recovery steps.
BEFORE LEAVING THE HOSPITAL