When you no longer need the amount or type 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 or type of care provided in the hospital, but you need more or different 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, or more help than you would have available
- Move safely between your sleeping area, bathroom, and kitchen.
- Go up and downstairs, if there is no 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 providers will help you regain your strength and ability to care for yourself:
- 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 from and sit down safely onto a chair, toilet, or bed. They may also help you relearn to climb steps and keep your balance. You may be taught to use a walker, cane, or crutches.
- Occupational therapists will teach you the skills you need to do everyday tasks at home.
- Speech and language therapists will evaluate and treat problems with swallowing, speaking, and understanding.
Centers for Medicare and Medicaid Services website. Skilled nursing facility (SNF) care. www.medicare.gov/coverage/skilled-nursing-facility-snf-care. Updated January 2015. Accessed September 3, 2021.
Gadbois EA, Tyler DA, Mor V. Selecting a skilled nursing facility for postacute care: individual and family perspectives. J Am Geriatr Soc. 2017;65(11):2459-2465. PMID: 28682444 pubmed.ncbi.nlm.nih.gov/28682444/.
Review Date 7/11/2021
Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.