By Victor Montour
When someone suffers from an injury or medical trauma, they may need to live at a rehabilitation center or skilled nursing facility for a short period of time. The goal for most people going to in-patient rehabilitation is to help the patient return to his/her maximum functional potential after suffering a life-altering event.
When someone is diagnosed with a life limiting disease they may need to look at a community based hospice. The goal for patients going into hospice is to provide physical, emotional and spiritual support to the patient and family while they enjoy life at home with family and friends while the patient’s disease process continues on a natural course.
In-patient rehabilitation is a rehabilitation service offered to people in a residential setting, rather than to people who travel to a clinic for rehabilitation appointments. These facilities are called skilled nursing facilities (SNF) or In-patient Physical Rehabilitation Centers. In-patient facilities could be located inside a hospital or senior housing, such as assisted living facilities and nursing homes.
These centers provide around-the-clock treatment and supervision. The patient’s progress is continuously monitored. In some cases, in-patient treatment programs stand a better chance of success for patients. Some common types of ailments that might be best treated (check with your doctor for the best advice) include:
- Joint injury or replacement
- Neurological conditions
- Arthritis of the spine and other joints
- Brain injury
- Nerve impingement
Community based hospice services are offered to people in a residential home or home like setting. Hospice care can all so be provided in some community facilities. Some of these facilities are called skilled nursing facilities (SNF), senior housing, or assisted living facilities.
Most community based hospice care is provided at home — with a family member typically serving as the primary caregiver. Medicare has strict clinical guidelines a patient must meet in order to receive hospice care in a hospital setting. This type of hospice care is very rare and should never be considered as the first line of treatment. Some common types of medical conditions that might be best treated in hospice (again check with your doctor for the best advice) include:
- Chronic Obstructive Pulmonary Disease (COPD)
- Congestive Heart Failure (CHF)
- Amyotrophic Lateral Sclerosis (ALS)
- Liver Failure
- Renal Failure
Duration of in-patient rehabilitation treatment varies depending on the severity of the condition and potential for improvement. The key words being potential for improvement. Families and patients should ask their doctors what the potential for improvement is for any treatment. If improvement is low or a decline in health continues then the next question should be, what about hospice?
Generally, significant results can be achieved in either program as long as you are placed in the appropriate program at the optimal time. People should enter into hospice as quickly as they do going into rehab. Hospice care should be a timely choice not a last resort. Currently this concept seems to differ widely depending on the condition being treated and the patient’s involvement in his/her care.
Many times, I see patients going to rehab who have a terminal diagnosis. I always ask myself, is this patient informed? Do they understand their diagnosis? Do they understand the diagnosis they have is terminal? Do they know they could spend their time with loved ones enjoying life instead of being alone or with strangers in a rehab facility?
As healthcare is everchanging it is the patient’s responsibility to know their diagnosis, to know best treatment options and to know when a diagnosis is terminal. Patient’s need to drive the conversation on what they want for care. Ask is hospice or rehab more appropriate? Ask what is the potential of cure or rehab? Let your doctor know what ‘enough’ looks like to you. Talk to your doctor about what you’re willing to do in rehab and what you’re not willing to do. You have to say ‘enough is enough’ when the time comes, so why not prepare people ahead of time. I have seen many people with a terminal diagnosis sent to rehab and even continue until death because they weren’t fully aware of the choices they had.
You are in charge of your healthcare so take charge and research your options. Educate others on what you want, when you want it.