Appropriate Level of Care for Rehabilitation Patients

Jul 09, 2014 at 04:50 pm by Staff

ORMOND BEACH – In the current era of health care reform and the criticism of medical expenses, providers are under fire to offer the appropriate level of care – the right intensity for the right patient at the right time. Nowhere is this challenge greater than with rehabilitative services.

Patients needing rehabilitation suffer from a wide range of issues with varying levels of severity, including stroke, spinal cord injury, major multiple trauma injuries, hip fractures, brain injuries and neurological disorders, among other conditions. The seriousness of an issue, of course, impacts the level of care appropriate for each patient, but the appropriate level of care also changes as a patient progresses and moves through the healthcare system. At Florida Hospital Memorial Medical Center, we use a targeted approach to offering the appropriate level of care for our patients – both inpatients and outpatients.

For example, our inpatient rehabilitation facility (IRF) – Florida Hospital Peninsula Rehabilitation – offers a very different level of care from a skilled nursing facility (SNF). IRFs provide each patient with a minimum of three hours of daily therapy for five days a week under a physician-directed care plan, which can include physical, occupational, speech and recreational therapy. Patients receive daily visits from physicians, as well as 24-hour rehabilitative nursing care from a staff with a greater nurse-to-patient ratio. At SNFs, in comparison, patients may not be seen daily by a physician, are not supervised as closely and have fewer nurses per patient. Because of these differences, research has shown that stroke patients who receive care in an IRF are more likely to return to living at home – and are able to return home sooner – than patients who receive treatment at a SNF. Patients’ average length of stay at Florida Hospital Peninsula Rehabilitation is only 14 days, compared to the SNF national average of 30 days length of stay.

From an outpatient perspective, a range of patient needs can be met by building services in a way that targets specific patient populations.

For example, therapists at our Amputee Clinic help patients during various stages of recovery to adapt physically and make necessary lifestyle changes. Some of the Amputee Clinic services include:

Pain management/phantom pain

Exercise education

Adaptive equipment

Walking analysis and training

Prosthetic training

Onsite prosthetic adjustments

Skin care

Onsite physician assessment

For cancer patients, our Cancer Rehabilitation Program is designed to help restore quality of life during and following treatment for cancer. Physical therapy may address lymphedema, cancer-related fatigue, weakness, range of motion, scar tissue, balance/coordination, neuropathy and pain. Occupational therapy aims to improve activities of daily living through home-safety modifications, visual/perceptual therapy, sensorimotor intervention and education in physical energy conservation. Speech therapy improves memory and problem-solving skills, speech and swallowing.

Considering appropriate level of care, outpatient rehabilitation can be hugely beneficial for patients because some conditions can be treated nonsurgically using physical therapy in an outpatient setting. With women’s health, for example, outpatient rehabilitation can address issues including incontinence, pelvic pain, endometriosis, sacroiliac joint pain and discomfort related to lumpectomy, mastectomy, breast implants and reconstructive surgery. One of our physical therapists has completed special training pertaining to women’s rehabilitative services, allowing her to tailor her therapy regimen particularly to patient needs.

The mission of organizations such as Florida Hospital Peninsula Rehabilitation, which has served central Florida residents for 20 years, is to restore independence and quality of life to our patients. As patients progress through the recovery process, let us consider not just the continuum of care, but the appropriate level of care.

Howard Perch serves as executive director for rehabilitative services at Florida Hospital Memorial Medical Center. To learn more, e-mail or visit

Sections: Events