NEW YORK (Reuters) - This summer, I had the arduous and rushed task of picking a rehabilitation center for my dad, as post-operative complications left him too ill to return home at the time, yet the hospital was keen to discharge him.
This is an endeavor few people think about. Recent market research by Genesis HealthCare shows that 96 percent of people between 60 and 75 don’t expect surgery or an injury over the next year. Some 83 percent could not name a single rehabilitation center.
“There’s no brand loyalty, no preferences - and that leaves the consumer out there with an A-Z list and not knowing what to do,” says Carol Rohrbaugh, a vice president of business development for Genesis, which has more than 400 care facilities across 28 states.
After my father’s first surgery in late July, my family - pushed for time - selected a place from a list of rehab centers provided by the hospital based on location.
This would seem a logical factor to have based the decision on. However, medication didn’t arrive on time, nurses were harried and the ward overcrowded with dementia patients, who were monitored in the hallways.
In fact, there are remarkable differences among rehab facilities, which I learned after my dad required a second surgery and further rehab. Some are the dingy warehouses of everyone’s nightmares while others resemble vacation spas.
Here's what the experts say on how you can pick the best rehab facility (See video here):
Just as you might know what hospital you’d wish to be admitted to in an emergency, consider what you’d do if you’re released from hospital but aren’t well enough to return home, advises Dr. Rebecca Boxer, a associate professor of medicine at the University of Colorado School of Medicine in Aurora.
“When people don’t know what they don’t know, it can be a disaster,” she says.
Research can be as simple as word-of-mouth recommendations. Get past a certain age and you’re bound to know somebody who stayed at a rehab center after a hip replacement, (or whose mother did). Find out about response time to the call button, medication management and food quality.
After my dad’s second hospital stay, we did more intensive research, branching out beyond the hospital’s provided list to stand-alone rehab centers and regional specialty centers.
We checked the Medicare ratings and any reviews that were available on web sites, but the information online was limited.
Medicare ratings can be misleading, too, says Boxer, because they measure limited criteria, like rate of flu vaccination, which has little bearing on helping my dad walk again.
Judging a place by looks can be deceiving, as fancy décor doesn’t mean there is good nursing care, says Bunni Dybnis, a certified geriatric care manager in the Los Angeles area.
“Sometimes, good to your eyes may not be good at all,” she says.
Dybnis suggests concentrating most on what the staff is doing. Are they waiting for the bell to go off or are they checking on patients constantly? What is happening at night?
There is a lot to be said for the “smell” test. The newer facilities that have spiffed up features - bistro-style dining, lounge areas with big TVs, ornate lobbies - definitely appealed to my family emotionally.
More telling are the hallways. Some traditional nursing homes I toured had rehab patients intermixed with long-term residents with serious disabilities, including dementia. That’s frightening for morale if you’re there with a broken hip.
A few had separate wings for short-term patients, with their own rehabilitation services and amenities. One was a hospital-level setting with specialty care for my dad’s condition, and one was only for rehab patients.
“Those that earmark a certain section for skilled rehab, that’s preferable than having it all mixed up with long-term care,” advises Boxer.
Two of the biggest nursing care systems, Genesis Health Systems and HCR ManorCare, are attempting to upgrade services for short-term rehab patients as they jockey for market share. Other systems are also adding new facilities.
Genesis has a growing chain of 10 Power Back centers that are for rehab only. All rooms are private, a chef prepares food in an open lobby kitchen and the TVs have 400 channels for a fee of $3 per day. (Disclosure: My dad ended up in one of these centers).
HCR ManorCare has MedBridge, short-term rehabs units among its 300 facilities in 32 states. While they’ve had these going on 10 years, they just started to conceptualize them as a product, with some in stand-alone buildings.
Care for the patient is all-inclusive on most plans, but that doesn’t mean there won’t be costs. Medicare covers 20 days at 100 percent after a qualifying hospital stay, and then charges a co-pay of $152 per day for the next 80 days.
Private insurance varies greatly, with some charging a daily co-pay of $25 to $50 and some having limits on the number of days covered.
If you’re paying out of pocket, costs run about $12,000 a month at HCR ManorCare facilities, says Julie DiCicco, manager of market development at HCR ManorCare. At-home care costs $20 per hour or more.
Incidentals can include phone and TV access, salon services, personal laundry and transport to medical appointments outside the facility.
Some experimental or “extra” therapies are not covered or only partially covered - such as Power Back’s rehab program to help people drive again, which can cost $300 to $600 out of pocket.
Family extras can add up quickly, especially if members need travel and lodging, not to mention the cost of lost time at work.
For those who can’t handle the list, there are geriatric care managers like Dybnis who work for hourly rates ranging from $80 to $135 an hour.
“A care manager in THE area where your parent is can have a lot of insight,” says Boxer, especially if you’re trying to triage care from far away. “They can be a lifesaver.”