In an IRF, the patient must be
capable of participating in three hours
of therapy every day. Those who need
inpatient rehabilitation or further skilled
care but cannot tolerate three hours of
daily therapy will need to go to a SNF
(many insurers will not cover IRF if the
survivor does not have the tolerance).
The rehabilitation resources, facility and
programs vary from SNF to SNF and
span the spectrum from those that offer
many rehabilitation services to those that
offer very few.
In the inpatient setting, Medicare
will cover up to 100 days in a SNF; up
to 90 days in an IRF (or longer in some
instances, although cost-sharing is very
high); and up to 60 days of services in the
home health setting. There are limits on
outpatient therapy services, particularly
by private insurers, that can be as short
as two to three weeks for physical,
occupational and speech therapy.
Because of these limits on coverage,
rehabilitation dollars are dear and should
be used wisely.
“Our recommendation is that, if at
all possible, patients should receive
their rehabilitation at an inpatient
rehabilitation facility,” Winstein said. If
that is not possible, because of logistics
or the survivor’s condition, then stroke
families should consider SNFs “that have
a coordinated rehab program, maybe at
a lower intensity, but they use a team
approach and have team meetings and
communicate regularly with the family.”
Finding such a place may require
some investigation. Medicare.gov posts
public quality ratings for SNFs within
their “Nursing Home Compare” feature.
You can search for a specific facility or
can enter a ZIP code for a list and can
create a side-by-side comparison of up
to three facilities at a time. You’ll see an
overview of rating categories and can
fter a stroke in 2010, Mark
Selman, age 60, of Alpharetta,
Georgia, needed no rehab
because he had no deficits after
the clot was removed by thrombectomy.
His doctors did discover that he had
atrial fibrillation and prescribed blood
thinners. He was back at work as a
financial advisor within a month.
That treatment did not prevent a
second stroke in June 2014. That one left
him paralyzed on his left side, unable to
swallow and on a feeding tube.
Within days, the medical team treating
him at Piedmont Hospital approached
Sherri, his wife of 22 years, with a list
of care facilities where he could be
transferred. Sherri would have none of
it: “I wouldn’t even look at the list because I knew where he needed to
go,” she said. “Anyone who has lived in Atlanta as long as I have knows
The Shepherd Center, which is connected to Piedmont Hospital via an
underground tunnel is the place for premier care in this area.”
In his condition, the nurses said, he could not qualify for admission,
because he could not do three and a half hours of rehab a day.
Sherri went to work. She called a friend who knew someone there.
Someone from admissions came to Mark’s room and interviewed Sherri
and Mark. “They could see that he was in good shape and that we had the
means to make the house accessible,” Sherri said. “They wanted to make
sure he would be released into a situation where he could succeed.” The
next day she toured the facility.
Mark could not do three and a half hours of rehab at one stretch,
but he could do an hour of work three times a day. So, his regimen was
modified. Over the five weeks he was there, he improved to the point that
he was doing five and a half hours of therapy a day. When he returned
home, he continued with OT, PT and speech therapy for 18 months, and
he has gotten back the use of his hand and arm. He still does therapy at
the gym where he walks with a cane and a gait belt. Although he is still
accompanied by a caregiver when he walks, he typically manages 6,000
steps a day, Sherri says. He also plays adaptive golf.
She credits the facility with setting the stage for that recovery. “I know if
we had gone to one of those other centers on the nurse’s list, he would not
have made this kind of recovery,” Sherri said. “Those places use a cookie-cutter approach. Shepherd customized their care to Mark’s needs.” Sherri
believes strongly that every stroke patient needs a strong advocate who will
ask the tough questions and do the research necessary. “Survivors’ recovery
is based on getting the best medical attention and therapy you can find.
Mark’s determination to get back a good quality of life, and also get back to
the game of golf he loves so much, was essential to his recovery.”
Survivor Mark Selman with wife Sherri