An NRH Field Guide for People with Disabilities
PART 1: MEDICAL REHABILITATION
- What is medical rehabilitation and how can it help me?
- Who will I work with during rehabilitation?
PART 2: HEALTH INSURANCE PLANS
- What rehabilitation programs and services will my health insurance cover?
- What are some different types of health insurance plans?
- What’s the difference between private and public health insurance plan payers?
- What does Medicare cover?
- What does Medicaid cover?
PART 3: CHOOSING A REHABILITATION PROGRAM
- How do rehabilitation programs differ?
- Will I need more than one kind of program?
PART 4: QUALITY AND REHABILITATION
- What is meant by ‘quality?’
- What are rehabilitation outcomes?
- What are some ways quality is measured at the individual level?
- What are some ways quality is measured at the organizational level?
Steps for Choosing a High-Quality Rehabilitation Program
STEP 1: Your Needs
What are your current rehabilitation needs?
- How healthy are you?
- How intense do you need rehabilitation to be?
- How severe is your condition?
STEP 2: Insurance
What kind of health insurance do you have?
Does your health insurance plan limit the amount and type of therapy or other services you can have?
STEP 3: Setting
What rehabilitation setting will best suit your needs?
- Acute rehabilitation facility
- Subacute rehabilitation facility
- Day rehabilitation
- Nursing home
- Skilled nursing facility
STEP 4: Quality Outcomes
Do the outcomes of programs you are considering reflect high-quality care?
- FIM scores
- Where past patients were discharged to (home, nursing home, or assisted living)
- Patient and family satisfaction
- JCAHO accreditation
- CARF accreditation
Selecting a high-quality medical rehabilitation program after you experience an injury or illness can be hard to do. You want a rehabilitation program that will give you the best possible care and that takes into account your own circumstances. For instance, you will want a program that considers how well you get around, the type of transportation you use, where you live, your level of family support, and your insurance coverage. You also want a program that will help you to become as independent as you can be in your daily living.
When it comes time to choose a rehabilitation program, where do you start? How can you tell which rehabilitation programs offer high-quality services that will meet your needs, and which programs will not?
Unfortunately, people often must decide where to go for rehabilitation when they do not have the time to gather details about all available programs. Typically, decisions about which rehabilitation program to use are made when a person is already in an acute care hospital. If someone has not talked with you or a family member within the first few days after being admitted to a hospital, ask to see a hospital social worker. The social worker can help you begin the process of choosing a rehabilitation program.
The goal of this guidebook is to help you to choose a high-quality rehabilitation program. It includes four major parts. Part 1 describes medical rehabilitation — what it is, how it can help you, and the different rehabilitation professionals who will work with you. Part 2 discusses health insurance plans so that you can understand what your plan will and will not cover. Part 3 talks about the different types of rehabilitation programs available to you, and Part 4 looks at ways that can help you find a high-quality rehabilitation program to suit your needs.
At the back of this guidebook, you will find a glossary of terms. When you are reading through this guidebook and see a word in boldface type, you can find out its meaning in the terms section. You can also look through the terms section first, to familiarize yourself with some of the words. You will see that next to each word is a page number where it appears in the text, if you
need further descriptions.
In addition, you will also find checklists to help you choose a high-quality rehabilitation program, as well as a listing of resources including organizations, Web sites, and phone numbers that might be useful.
After reading this guidebook, you should have a better understanding of how to find a good quality medical rehabilitation program.
By becoming more informed, you will be better prepared to choose a program that meets your health care needs and helps you to be as independent as possible.
Martin’s Story: The Road to Recovery
In the summer of 1999, Martin was an active 42- year-old who rode his bike 20 miles roundtrip to work each day. One weekend, as he was gearing up for a long ride and putting on his cycling shoes, he suddenly lost all feeling in his right arm and leg. There was no pain, no sickness, no blurred vision — just no feeling.
Martin was taken right away to an acute care hospital where he learned he had a mild stroke. Two weeks later, he transferred to a rehabilitation hospital where he could rebuild his strength and relearn skills needed for independent living. After his intensive inpatient rehabilitation, he continued with weekly outpatient therapy.
For Martin and others, the changes that come with disability can create lifestyle challenges. Medical rehabilitation helps to identify each person’s abilities and finds ways to use those abilities and new skills in daily life.
One of Martin’s biggest challenges after his stroke was learning how to do things with his left hand, even though he was right-handed. “I had to learn how to brush my teeth with my left hand. That seems simple enough, but it’s been a long, difficult process. In the end, it’s been worth it to still be able to do many things for myself.”
Martin found that confidence, self-esteem, and support from family and friends played a big part in his rehabilitation and recovery. “Rehabilitation is about believing in yourself, knowing that you can get better with determination,” he reflected. “It’s not easy, but my family and therapists were very supportive.”
After rehabilitation, Martin joined a stroke support group. This group of stroke survivors and family members met each month to talk about their experiences. Personal achievements were also shared as a way to inspire others to reach their own personal goals.
Years later and almost fully recovered, Martin is still an active member of the stroke support group. In fact, he now bikes to and from the meetings each month.
For the rest of this comprehensive guide, click here.
This guidebook was developed with a grant awarded to the Health & Disability Research Institute at Boston University from the National Institute on Disability and Rehabilitation Research (NIDRR): Rehabilitation Research and Training Center for Measuring Rehabilitation Outcomes, Grant No. H133B990005.
The creators of this guidebook acknowledge and thank Paul Rao, PhD, and Michelle Rives, MPH, who were the authors of the National Rehabilitation Hospital’s publication, A Consumer Guide for People with Stroke: Choosing a Rehabilitation Program, on which this guidebook is largely based.
We would also like to thank the following individuals for their time and efforts in reviewing this guidebook and providing valuable consumer feedback: Marcus Bell, Bertha Joachin, and Robert Sevigny, in addition to all of the other reviewers for their insightful comments, time, and energy.
This guidebook was prepared by Melinda T. Neri at the National Rehabilitation Hospital Center for Health and Disability Research in Washington, DC and designed by Flannery Studios in Montgomery Village, MD.