LEVEL OF CARE/FACILITY COMPARISON:IRF LTACH SNF LTC/ ALF/ILF

Licensure: Rehabilitation Hospital

Acute Hospital Skilled Nursing Facility

N/A- considered a home environment

Medicare certification: Rehabilitation Hospital

Long-Term Acute Hospital

Skilled Nursing Facility

Home services

Admitting criteria: 60% must fall into CMS-13 diagnoses

Meets acute criteria (medically complex)

Meets chronic care criteria

LTC- dependent or needs supervisionALF- requires some assistance for mobility/ADLsILF-independent behind closed doors

Length of stay: Typically 12-18 days (variable)

Average 25 days Variable- up to 100 days (avg. 35-40 general medical vs. 7-15 days orthopedic)

Variable- short term to permanent residence

MD requirements: PMR primary (3 times/wk)+ consultants

Daily visits by hospitalists/consultants

Physician visits monthly

None-home visits or outpatient office visits

Manage critically ill patients?

NO YES NO NO

Patient types: Polytrauma, CVA, TBI, SCI, amputee,Burns, major orthopedic, neuro

Typically after illness from pulmonary/cardiac disease or infection

Typically requires therapy services to improve mobility after uncomplicated surgery or a hospital stay

LTC- debilitated with wounds, IVF, nursing needsALF-debilitated, medically stablizedILF- high functioning geriatric

Rehab dosage: Minimum of 3 hrs/day, 5 days/wk;> 2 rehab disciplines (PT, OT, Speech)

Avg. 1 hr/day, ranges from 0-3 hrs/day

> 2.25 hours/day; average approximately 1.5 hours/day

Variable- tends to be episodic home health or outpatient care to address specific issues or develop restorative program

Criteria for rehab services:

Must tolerate 3 hrs/day & show functional progress

Must be medically stable enough to participate, show progress or be indicated to prevent secondary complications

Depends upon RUG level- Has to have the potential to improve function or prevent complications

Has to have the potential to improve function or prevent complications

Covered by: Medicare /Private insurance (some Medicaid)

Medicare/Private insurance (some Medicaid)

Medicare/Private insurance (some Medicaid)

Medicare Part B

Payment structure: PPS/DRG DRG Daily level (based upon RUG)

Outpatient PT/SLP and OT- each with dollar cap