When you no longer need the amount of care provided in the hospital, the hospital will begin the process to discharge you.
Most people hope to go directly home from the hospital. Even if you and your doctor planned for you to go home, your recovery may be slower than expected. As a result, you may need to be transferred to a skilled nursing or rehabilitation facility.
Who Needs to go to a Skilled Nursing or Rehabilitation Facility?
Your health care provider may determine that you no longer need the amount of care provided in the hospital, but you need more care than you and your loved ones can manage at home.
Before you can go home from the hospital, you should be able to:
- Safely use your cane, walker, crutches, or wheelchair.
- Get in and out of a chair or bed without needing much help.
- Move safely between your sleeping area, bathroom, and kitchen.
- Go up and down stairs, if there is no other way to avoid them in your home.
Other factors may also prevent you from going directly home from the hospital, such as:
- Not enough help at home
- Because of where you live, you need to be stronger or more mobile before going home
- Medical problems, such as diabetes, lung problems, and heart problems, that are not well controlled
- Medicines that cannot safely be given at home
- Surgical wounds that need frequent care
Common medical problems that often lead to skilled nursing or rehabilitation facility care include:
- Joint replacement surgery, such as for the knees, hips, or shoulders
- Long stays in the hospital for any medical problem
- Stroke or other brain injury
If you can, plan ahead and learn how to choose the best facility for you.
What Happens During Your Stay?
At the skilled nursing facility, a doctor will supervise your care. Other trained health care providers will help you grow stronger:
- Registered nurses will care for your wound, give you the right medicines, and monitor other medical problems.
- Physical therapists will teach you how to make your muscles stronger. They may help you learn how to get up and sit down safely from a chair, toilet, or bed. They may also teach you how to climb steps, keep your balance, and use your walker, cane, or crutches.
- Occupational therapists will teach you the skills you need to do every day tasks at home.
- Speech and language therapists will evaluate and treat problems with swallowing, speaking, and understanding.
Centers for Medicare and Medicaid Services. Medicare coverage of skilled nursing facility care. www.medicare.gov/Pubs/pdf/10153.pdf. Accessed October 1, 2015.
Review Date 8/29/2015
Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.