Most patients do not go straight home after surgery, but will instead go for inpatient rehabilitation, either in an acute setting (if they have the stamina to participate in three hours of rehab daily), or in a sub-acute setting (usually a nursing home; ideally, one that segregates their short-term patient units from long-term care units), if physical or occupational therapy is needed. Acute stays are typically between 2-3 weeks while a sub-acute stay could be for up to 100 days if you have traditional Medicare and are showing improvement. Traditional Medicare pays all costs for sub-acute rehab for the first 20 days, then 80% for the rest of the stay. If you have a “medi-gap” policy it will pay the remaining 20% not paid by Medicare. If you have a Medicare Advantage policy (an HMO), the duration in sub-acute rehab is determined by the HMO.
After inpatient stay, you will receive in-home rehabilitation, CHHA (certified home health agency) services, which might include physical therapy, occupational therapy, and speech therapy twice or three times per week, and typically twenty hours per week homecare for the first 4-5 weeks of CHHA services. The amount of homecare hours is reduced over the period of CHHA services – typically a nine-week course of care. Often, CHHA services can be recertified upon receipt of a “prescription” for additional therapy from the patient’s physician.
The goal of CHHA services is to get patients literally back on their feet, back to where they were, or well enough to continue getting treatment in an outpatient rehabilitation center. This is the only type of rehabilitation that Medicare will pay for maintenance, as the other rehabilitation programs are for “restorative functioning”.