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Acute rehabilitation tries to restore the premorbid physical and mental functioning of patients as much as possible by increasing muscle strength and patient endurance, improving muscular coordination and control, and providing adaptive equipment when necessary. Choosing the appropriate setting for provision of the needed services requires a working knowledge of the different levels of care available for rehabilitation services—acute inpatient rehabilitation, subacute rehabilitation, outpatient rehabilitation, and home health services. Determinants of the appropriate level of care include the functional limitations of the patient, the need for medical monitoring, social support, cognitive functioning, nursing needs, therapeutic disciplines required, and ability to tolerate three hours of therapy a day.

The Centers for Medicaid and Medicare Services recently instituted a prospective payment system for acute inpatient rehabilitation facilities. For Medicare approved facilities, a certain percentage of all admitted patients must have 1 of 13 diagnoses: stroke, brain injury, burns, SCI, neurological disorders, major multiple trauma, congenital abnormalities, inflammatory polyarthritis with impairments of ambulation and ADLs that have not responded to less intensive therapies, amputations, hip fractures, bilateral joint replacements, and unilateral joint replacements in individuals > 80 years old or the morbidly obese. Rehabilitation centers must provide, and patients admitted to the acute rehabilitation center must require, interdisciplinary, team-based care, 24-hour rehabilitation nursing, daily physician assessment, and three hours of therapy daily. The interdisciplinary team in acute rehabilitation facilities consists of a physician leader, registered nurse (RN) with rehabilitation certification or expertise, physical therapy, occupational therapy, speech therapy, therapeutic recreation, social work, nutrition, neuropsychology, and often psychology, an orthotist, prosthetist, and a chaplain. Patients receive therapy five to seven days a week (Table 66-1).

Table 66-1 Criteria for Admission to Acute Rehabilitation

Long-term acute care (LTAC) facilities may also provide daily therapies using speech (ST), physical ...

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