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  • Average Length of Inpatient Rehab Stay - ?

    I'm currently in inpatient rehab. I've been here for just under 8 weeks. I realize there will be a vast range depending on level of injury or medical complications that arise while inpatient - as well as limits placed by one's insurance company. However, for those who were still "making progress," how or why were you discharged at your date? Was it the center that made you leave, or your insurance?

    Please mention what country you are from as well if you don't mind, as I've noticed the US limits are more strict.

    After I leave inpatient, I'm looking at 2-3 hours a week! This is a HUGE change from the 4 hours of therapy a day that I'm getting at the moment.

    It was really difficult selecting a rehab center while in ICU. We had no idea at the time of what to really ask, or to expect. I was also wondering if there is any skill you wish you'd started or learned in inpatient rehab that you didn't get a chance to try, or you just didn't know?
    "Get busy living, or get busy dying." - Andy

  • #2
    According to Model SCI System data, the average SCI rehab length of stay for all levels of injury is 36 days (as of 2006). The average for those with paraplegia is now 18 days, and for those with tetraplegia, it is approximately 5 weeks. While the rehab centers have changed their programs to shorten lengths of stay and push people out faster, this has been entirely driven by the insurance industry who are loath to pay for expensive inpatient comprehensive rehabilitation, esp. at a SCI specialty center.

    This will usually be longer in the VA system, where insurance does not determine care or length of stay, and often worker's comp is the most liberal in the private sector.

    In my experience, the shorter lengths of stay have resulted in people being less independent in bowel and bladder care, transfers, and in high level wheelchair skills (such as wheelies) and often there is insufficient education in wellness and health management as well as sexuality. These topics are either left out entirely, or if covered, often the person is not emotionally in the right place to hear them this soon after injury.

    It is unfortunate that many people do not know or get advised to come here, or contact organizations such as the CDRPF or NSCIA for help in choosing an SCI rehab program immediately after injury. The Consortium for Spinal Cord Medicine's new clinical practice guideline on New Injury care in the first 72 hours needs wider dissemination to ERs and ICUs. The family version of this (which will be formated as FAQs) should be available next spring and will also need to be well disseminated to be useful for those who are newly injured.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


    • #3
      This can be a very frustrating issue. I remember well having your exact questions.

      My father was at a very reputable SCI rehab center. He stayed for almost 4 months as an inpatient. He had many traumatic injuries in addition to his T11 fracture to recover from. But we pushed like crazy to keep him there, and stressed-out so much since no one really explained how the system worked and how decisions were made regarding length of stay. Often they deflect it to other people.... "the doctor.... the therapists recommendations... your insurance...." so you never know what the true deciding factor is. They almost sent him home after 6 weeks, thinking that he had too many problems that would limit him in rehab (we were not told this directly). So we pushed him like crazy, talked to his best/sweetest/most wonderful OT therapist and let her know how much we wanted to stay and she pulled for us.

      First, know the exact details of your insurance policy and what your coverage is. If that is limiting in any way, it obviously influences the rehab hospital. The patients who had the longest stays were the workman's comp patients.

      Next, know exactly what your current goals are, and what criteria the therapists will use to decide if you will be extended. Ask them. Ask your doctor. Look them in the eye while you are talking to them - this is very important. And work your butt off! Exercise more on your spare time. Discuss the progress you have made in detail, and the things you still need to learn/improve. If they are having trouble coming up with goals that can be attained in a reasonable amount of time, give them some! Anything that can make you more independent can be a goal.... as you have noticed, many of their goals are related to function and not simply "more arm strength... able to wiggle toes... " etc.. although these things are important. Suggest things such as dressing, all transfers (to shower chair, commode, car), transfers from walker to all these things and from wheelchair, dressing, and then increasing your speed at any task/exercise. Ask to get on a treadmill (body weight assisted treadmill training, that will help improve your stride rhythm and walking speed long term)... do they have a pool? Is there a recumbant bike you have been riding (they can have a goal be speed/time on bike) or one with FES? Have they done any electrical stimulation on any of your weak muscles? Are there any orthotics that you need that they should be making for your - a KAFO (knee ankle foot orthoses) or AFO (ankle foot orthoses) to help support your weak leg? Is there is anything you have seen other people do, that you haven't tried yet? Ask if you can try it.

      They cannot send you home if you don't have a safe place to go and aren't safe. So if you need to learn anything that will keep you more safe, then that is an essential goal!

      Of note, the therapists often have to quantitate improvement, which can be hard. And sometimes there are criteria they must satisfy that must be documented - whether these are criteria your insurance have made or they have made is often unclear. One example is increasing your walking speed, or wheelchair mobility speed.... I sensed that the walking speed is a big one for people who are improving quickly and are ambulatory.

      The SCI nurse is exactly right that many very important skills get neglected, so ask for vocational rehab (you want to work again one day, right?), skills for re-entry to the community (walking/wheelchairing outside), advanced wheelchair skills (wheelies are useful). And ask a lot of questions about bowel/bladder (you want to be completely independent in these... that is a goal!!), skin care etc...

      Also, perhaps you need to be looking more carefully into outpatient programs, and what your insurance limitations are. Do you have a cap for coverage per year? Does it cover pool therapy? Some Rehab centers have what are called Day Rehabilitation programs. Often they are affiliated with a rehab hospital, and are multiple days a week for multiple hours each day. They are for individuals with needs for rehab in at least 2 disciplines - example PT and OT - and they often offer speech, vocational rehab, neuropsych etc.. You should definitely qualify for PT and OT needs (and keep asking for vocational.... the potential for returning to work is definitely a goal that is a big one that can prolong outpatient therapy as well, in some cases).

      Of note, ultimately the decision to discharge in our case was made solely by the Rehab hospital. Our insurance never called once to ask why he was there so long. As my father's primary insurance is Medicare (ouch.... they pay doctors/therapists at a very very low rate), the rehab likely LOOSES money on Medicare patients. So it was essential (I suspect) that we were at a large rehab hospital//teaching hospital that could "afford" to take care of Medicare patients.

      But we must admit, no matter how much therapy you get, it will never be enough in your mind. But that is also a good sign in my mind, as it is clear that you are very driven to fight for what you need from your providers and for your recovery. That is so important!!! Keep fighting. And it is wonderful news that you are making progress so quickly. So instead of 4 hours a day of therapy, start doing an extra hour on your own of stretching/working on your weakest areas. You can do it!

      Good luck tulips.
      Last edited by hlh; 10-16-2008, 11:01 AM.

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      • #4
        Level: T12/l2
        Stay: 8 weeks
        Place: Canada

        I was the one to decide im ready to leave.
        -----------------------------------------------------------------------------------

        T12/L2 Complete - Nov. 12, 2007


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        • #5
          T12
          Sept 20 - Thanksgiving
          I had a surgery in the middle there that let me stay longer. Also insisted that I not leave until I could do a floor transfer because my almost ex refused to build a ramp (drama I know) I knew I would have to get up steps to get in my home. Also that no safe place to go kept me there longer.

          After reading here for so long I see how lucky I was to stay so long and wish I still had such good insurance.
          If you can't handle me at my worst, then you sure as hell don't deserve me at my best.


          Sometimes it is easier to widen doors than it is to open minds.

          Comment


          • #6
            t7-8, 2005, 2 1/2 months. I also had additional surgery while there that slowed things down a bit. Decision was based on the fact that I was ready, and wanted to go, although I doubt insurance would have cooperated much longer. At the end they were extending it a few days at a time.


            I am sure your policy has a limit on outpatient visits. If you go for multiple disciplines, find out if a day with OT, PT and pool therapy for example counts as ONE visit or THREE. It will make a big difference in what you will be able to receive.

            (us)
            Last edited by sjean423; 10-16-2008, 03:09 PM.
            T7-8 since Feb 2005

            Comment


            • #7
              almost 6 months(inpatient)....i was injured on the job (workmans comp) so i was pretty lucky. i just stopped out patient therapy and i am 1 yr PO now. i will start outpatient again in dec. after an epidural & botox injections in my forearms again....prob for another 8 wks or so??

              i live in california
              I have a spinal cord injury...a spinal cord injury DOES NOT have me!

              walking quad-Central Cord Syndrome

              Comment


              • #8
                T12 complete

                2 1/2 weeks in rehab, they didn't want to let me go but I kept pushing untill they did

                I was back at work 5 weeks from the date of my injury

                Located in Houston Texas when injured in March of '99

                Comment


                • #9
                  C-5/6 but I crushed C5 and didn't have any C6 function for about a year. Now all my C6 function is basically on my right side. I've been injured for over eight years and I spent 3 months in rehab. When you get out, make sure you sign up for outpatient therapies. Don't forget about all the time a day at home you'll spend learning how to do stuff on your own, stretching and who knows what else you'll be doing throughout the day that they would work on at rehab. Trust me, you'll get quite a workout with all that stuff
                  C-5/6, 7-9-2000
                  Scottsdale, AZ

                  Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

                  Comment


                  • #10
                    Length of rehab

                    Originally posted by meglovestulips View Post
                    I'm currently in inpatient rehab. I've been here for just under 8 weeks. I realize there will be a vast range depending on level of injury or medical complications that arise while inpatient - as well as limits placed by one's insurance company. However, for those who were still "making progress," how or why were you discharged at your date? Was it the center that made you leave, or your insurance?

                    Please mention what country you are from as well if you don't mind, as I've noticed the US limits are more strict.

                    After I leave inpatient, I'm looking at 2-3 hours a week! This is a HUGE change from the 4 hours of therapy a day that I'm getting at the moment.

                    It was really difficult selecting a rehab center while in ICU. We had no idea at the time of what to really ask, or to expect. I was also wondering if there is any skill you wish you'd started or learned in inpatient rehab that you didn't get a chance to try, or you just didn't know?
                    My daughter's rehab in Dallas, Tx was 2 month program (insurance preapproved) after being airlifted from LA b/c we live in Texas. She only gets in home PT maybe 2 times a week at maybe 1 hr. 15 min session b/c of her class schedule at college. Currently working on transfers b/c she didn't have the upper arm strength to do transfers during her hospital stay. Do as much to feed/wash face/ brush teeth if you can b/c it helps out your family members before you come home. My daughter's OT made her some devices to help her brush her teeth by herself and she decided she was going to use the computer when she got home. So we have put typing sticks/w eraser on end of sticks to be able to touch keys, sticks inserted in her universal cuffs works great.
                    Insurance (BCBS) only allows you 50 visits a yr of PT/OT. which doesn't seem like that much since in hospital she received 3 hrs a day 4 times a week in the 2 mos. of rehab. Also noticed our daughter's nerve pain was less and spasms were less when she was getting more PT in hospital. She's 1 1/2 yrs. since her c5 c6 injury and I have noticed since she left hospital her nerve pain and spasms have gotten worse and she's had to have a few medication changes and started taking Zanaflex for spasms at night so she could sleep. We are looking into HealthSouth a program here in Arlington that uses auto ambulator/lokomotor to help her along with walking and bearing weight on legs. Studies have shown increase in bone density, muscle tone improves and some studies have shown decrease in spasms and nerve pain. Also good idea to get fitted with a standing frame. Most insurance companies will cover this device. Get with your social worker at hospital if you still in hospital and discuss with them various equipment you will be needing like a special bed w/airloss mattress to help keep you pressure sore free, also an insurance DME (durable medical equipment supplies). Good luck to you. You've found a good place for info. for sci people.
                    Aggie Mom 2007

                    Comment


                    • #11
                      5 months in rehab centre =
                      1 month bedrest after laminectomy, 4 months rehabbing
                      Level of injury T4
                      England
                      Only left rehab when both I and the professionals thought it was time.

                      This length of stay is not uncommon for people with paraplegia in the UK, I believe.

                      Comment


                      • #12
                        6 month of SCI rehab in Norway, I am a T12 incomplete. This is the same today if there is no complications. I was in the hospital for two month before rehab, that is not common anymore. It happens people are kicked out of rehab before, if they don't do their job.

                        9 month of rehab for the tetraplegics, I think.

                        Strange system here. Three month in rehab, then 2 weeks in a nursing home and then back to the rehab for three month. Some is sent to another rehab senter for four weeks and then back again for the SCI rehab.
                        TH 12, 43 years post

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                        • #13
                          3 weeks in the hospital-one week longer because of my stroke and heart patch surgery. I am T8 "complete".

                          4 weeks in a regular hospital rehab. We had no direction on where to go. My insurance will only cover 60 days. I have just in the past year learned to cath from my chair and drive. I still am terrible at transfers and breaking down my chair. Things to work on I guess.

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                          • #14
                            Originally posted by woman from Europe View Post
                            6 month of SCI rehab in Norway, I am a T12 incomplete. This is the same today if there is no complications. I was in the hospital for two month before rehab, that is not common anymore. It happens people are kicked out of rehab before, if they don't do their job.

                            9 month of rehab for the tetraplegics, I think.

                            Strange system here. Three month in rehab, then 2 weeks in a nursing home and then back to the rehab for three month. Some is sent to another rehab senter for four weeks and then back again for the SCI rehab.
                            Sure all can be better, but what you post here is not correct by any means. All is wrong, stay, level of injury for such etc. Nursing home? Whom get there? Please post facts next time.

                            Comment


                            • #15
                              I was in Neuro ICU 6 days, general hospital ward for 4 days (until a bed opened up at TIRR.) I think I was at TIRR rehab for 8 weeks, sent home for a month until I got my c-collar off, readmitted to TIRR for 2 more weeks for stuff I couldn't do w/ c-collar on.

                              C5-6 incomplete, but of course at that stage I think we all function pretty much like complete injuries. I definitely did. I had no other significant injuries besides SCI.

                              I knew from my life (mom = a stroke victim) that rehab was paramount. I worked my ASS off. The only trouble I got into was sneaking into the gym to work out when I wasn't scheduled. Never missed a class. Only time in bed was when they made me go b/c I was clearly sick. The only thing I ever refused was having my husband learn bowel care.

                              My point is, I was sent home because my insurance coverage ran out. I still was improving, and I was very very compliant. I may sound defensive. My stepmom insisted I must be being kicked out b/c she knew a para in the 60's that was in rehab for 6 months. Well, in America in 2000, that was not the game any longer. I'm still mad at her for saying that. I worked SO HARD.

                              Rehab is your last, best hope. Maximize every minute of it!

                              The best thing that happened to me afterwards was that the VA in Houston was running a research study. They needed ppl w/ my type of injury to do Suspended Treadmill Ambulation Training. This was 60 days, an hour a day, of hanging by a harness over a treadmill, a PT at each foot. They slowly increased the amount of weight I was bearing. It was grueling, and the simple process of getting there and back daily was another endurance test entirely. It took me 6 or 7 hours a day to get there, work out and get home unless I happened to have a family member who could drive me around (rare). Took twice as long to complete as it should have b/c I was wrestling w/ UTI's, was single-parenting an 11 yr old, had my house on the market. Aaaarrrgghhh, what a year. Rehab was a picnic compared to the rest of that year. But at the end of it, I was STRONG.

                              When that ran out is when I hit my wall.

                              If you live or can live near a metro area, ask around about exercise based research programs. They are still taking place, I'm sure. The last one I heard of was a year ago, in S. Carolina.

                              I think I should add-I was 40, so not a spring chicken. By the end of that 1st yr, I could walk very short distances w/ 2 forearm crutches.
                              Last edited by betheny; 10-19-2008, 12:29 AM.
                              Blog:
                              Does This Wheelchair Make My Ass Look Fat?

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