Quality Rehab Medicine

Choosing a High-Quality
Medical Rehabilitation Program:

AN NRH FIELD GUIDE FOR PEOPLE WITH DISABILITIES
Choosing a High-Quality
Medical Rehabilitation Program:
AN NRH FIELD GUIDE FOR PEOPLE WITH DISABILITIES
TO DOWNLOAD A PDF VERSION OF THIS GUIDEBOOK, GO TO WWW.NRHRESEARCH.ORG/CHDR/REHABGUIDE

OR WWW.BU.EDU / HDR/CONSUMERGUIDE.PDF
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ACKNOWLEDGEMENTS
This guidebook was developed with a grant awarded to the Health & Disability
Research Institute at Boston University from the National Institute on Disability and
Rehabilitation Research (NIDRR): Rehabilitation Research and Training Center for
Measuring Rehabilitation Outcomes, Grant No. H133B990005.
The creators of this guidebook acknowledge and thank Paul Rao, PhD, and
Michelle Rives, MPH, who were the authors of the National Rehabilitation
Hospitals publication, A Consumer Guide for People with Stroke: Choosing a
Rehabilitation Program, on which this guidebook is largely based.
We would also like to thank the following individuals for their time and efforts in
reviewing this guidebook and providing valuable consumer feedback: Marcus Bell,
Bertha Joachin, and Robert Sevigny, in addition to all of the other reviewers for
their insightful comments, time, and energy.
This guidebook was prepared by Melinda T. Neri at the National Rehabilitation

Hospital Center for Health and Disability Research in Washington, DC and designed
by Flannery Studios in Montgomery Village, MD.
CHOOSING A HIGH-QUALITY MEDICAL REHABILITATION PROGRAM
Contents
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
PART 1: MEDICAL REHABILITATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

What is medical rehabilitation and how can it help me? . . . . . . . . . . . . . . . . . . . . . . .3
Who will I work with during rehabilitation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
PART 2: HEALTH INSURANCE PLANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

What rehabilitation programs and services will my health insurance cover? . . . . . . . .7
What are some different types of health insurance plans? . . . . . . . . . . . . . . . . . . . . . .7
Whats the difference between private and public health insurance plan payers? . . . .8
What does Medicare cover? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
What does Medicaid cover? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
PART 3: CHOOSING A REHABILITATION PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

How do rehabilitation programs differ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Will I need more than one kind of program? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
PART 4: QUALITY AND REHABILITATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

What is meant by quality? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
What are rehabilitation outcomes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
What are some ways quality is measured at the individual level? . . . . . . . . . . . . . . . .19
What are some ways quality is measured at the organizational level? . . . . . . . . . . . .21
TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
QUALITY CHECKLISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
NRH Center for Health and Disability Research iii

STEPS FOR CHOOSING A HIGH-QUALITY REHABILITATION PROGRAM
iv NRH Center for Health and Disability Research

Introduction
S
electing a high-quality medical reha-
bilitation program after you experi-
ence an injury or illness can be hard
to do. You want a rehabilitation program
that will give you the best possible care choose a high-quality rehabilitation pro-
and that takes into account your own cir- gram. It includes four major parts. Part 1
cumstances. For instance, you will want a describes medical rehabilitationwhat it
program that considers how well you get is, how it can help you, and the different
around, the type of transportation you use, rehabilitation professionals who will work
where you live, your level of family sup- with you. Part 2 discusses health insurance
port, and your insurance coverage. You plans so that you can understand what
also want a program that will help you to your plan will and will not cover. Part 3
become as independent as you can be in talks about the different types of rehabili-
your daily living. tation programs available to you, and Part
4 looks at ways that can help you find a
When it comes time to choose a rehabilita-
high-quality rehabilitation program to suit
tion program, where do you start? How
your needs.
can you tell which rehabilitation programs
offer high-quality services that will meet At the back of this guidebook, you will find
your needs, and which programs will not? a glossary of terms. When you are reading
through this guidebook and see a word in
Unfortunately, people often must decide
boldface type, you can find out its mean-
where to go for rehabilitation when they
ing in the terms section. You can also look
do not have the time to gather details
through the terms section first, to familiar-
about all available programs. Typically,
ize yourself with some of the words. You
decisions about which rehabilitation pro-
will see that next to each word is a page
gram to use are made when a person is
number where it appears in the text, if you
already in an acute care hospital. If some-
need further descriptions.
one has not talked with you or a family
member within the first few days after In addition, you will also find checklists to
being admitted to a hospital, ask to see a help you choose a high-quality rehabilita-
hospital social worker. The social worker tion program, as well as a listing of
can help you begin the process of choosing resources including organizations, Web
a rehabilitation program. sites, and phone numbers that might be
useful.
The goal of this guidebook is to help you to
NRH Center for Health and Disability Research 1

After reading this guidebook, you should will be better prepared to choose a pro-
have a better understanding of how to find gram that meets your health care needs
a good quality medical rehabilitation pro- and helps you to be as independent as
gram. By becoming more informed, you possible.
MARTINS STORY: THE ROAD TO RECOVERY

In the summer of 1999, For Martin and others, the his rehabilitation and
Martin was an active 42- changes that come with recovery. Rehabilitation is
year-old who rode his bike disability can create about believing in yourself,
20 miles roundtrip to work lifestyle challenges. Medical knowing that you can get
each day. One weekend, as rehabilitation helps to better with determination,
he was gearing up for a identify each persons abili- he reflected. Its not easy,
long ride and putting on ties and finds ways to use but my family and thera-
his cycling shoes, he sud- those abilities and new pists were very supportive.
denly lost all feeling in his skills in daily life.
After rehabilitation, Martin
right arm and leg. There
One of Martins biggest joined a stroke support
was no pain, no sickness,
challenges after his stroke group. This group of stroke
no blurred visionjust no
was learning how to do survivors and family mem-
feeling.
things with his left hand, bers met each month to
Martin was taken right even though he was right- talk about their experi-
away to an acute care handed. I had to learn ences. Personal achieve-
hospital where he learned how to brush my teeth ments were also shared as
he had a mild stroke. Two with my left hand. That a way to inspire others to
weeks later, he transferred seems simple enough, but reach their own personal
to a rehabilitation hospital its been a long, difficult goals.
where he could rebuild his process. In the end, its
Years later and almost fully
strength and relearn skills been worth it to still be
recovered, Martin is still an
needed for independent able to do many things for
active member of the
living. After his intensive myself.
stroke support group. In
inpatient rehabilitation,
Martin found that confi- fact, he now bikes to and
he continued with weekly
dence, self-esteem, and from the meetings each
outpatient therapy.
support from family and month.
friends played a big part in
2 NRH Center for Health and Disability Research

MEDICAL REHABILITATION
PART 1:
Medical
Rehabilitation
PART 1:
Medical
Rehabilitation
I
ts important to try to understand some to walk on a flat, indoor surface where
of the basic concepts about disability. there are no curbs or steps.
To begin with, how well you function
Performance is ones ability to do a cer-
depends on your health, where and how
tain task in a real-world setting that may
you live, and other individual factors.
have barriers, such as steps, uneven
Living with a disability means that your
ground, or bad weather. Although you
body might not be able to function fully. It
might have the capacity to walk, the envi-
also means that you might be limited in
ronment affects your real walking per-
doing some tasks or taking part in some
formance. It makes it harder for you to
activities.
function and plays a part in your disability.
Capacity and performance are two terms
that can help you understand how your WHAT IS MEDICAL REHABILITATION AND
functional ability relates to the concept HOW CAN IT HELP ME?
of disability. Capacity refers to ones abil- Treatment for disability or illness most
ity to do an activity in a barrier-free place. often begins with acute medical care.
For example, you might have the capacity This medical care usually is provided in an
KERRYS STORY: THE ENVIRONMENT AND DISABILITY

Kerry was 19 and working since the injury. He is able bad weather. For example,
as a summer house painter to function and walk inde- rains hinders his walking
when he fell from a ladder pendently with his braces performance because the
and sustained an incom- and uses public transporta- sidewalks get slick. When
plete spinal cord injury. tion to get to and from the sidewalks get slick, it is
After his injury and rehabil- work. However, the physi- harder for him to walk
iation, he had a reduced cal environment sometimes safely from the subway to
capacity for walking and makes walking difficult. his office building. When
needed to wear braces to its not raining and the
The environment plays a
help him get around. sidewalks arent slick, Kerry
role in Kerrys disability
doesnt have to worry as
Kerry has been living a because his walking per-
much about falling.
productive and full life formance is more limited in

acute care hospital before you begin Medical rehabilitation can help you to live
rehabilitation. Acute medical care seeks to as independently as possible with your dis-
stabilize your condition and lessen any ability. It helps to reduce the effects of any
further complications. Rehabilitation problems you may experience after your
begins after you are stable and your injury or illness. Rehabilitation uses a care-
doctors think you will have no more fully planned program to help you regain
complications. your ability to function on your own at
MEDICAL REHABILITATION IS DIFFERENT FOR EVERYONE

The rehabilitation process good progress while there. was looking for. Within
is different for everyone. It months, she was making
Looking back, Elvira now
depends on many different the progress that she knew
knows that in rural Costa
things, including how you she was capable of. Being
Rica she wasnt getting the
are injured or become ill, near supportive family and
rehabilitation services and
how old you are when this friends, Elvira also received
professional and emotional
happens, where you live, the encouragement and
support that she needed to
and the resources and serv- support that she needed
make progress. After 6
ices that are available to to help her. She was
months recovering in Costa
you. Most importantly, it now highly motivated
Rica, Elvira decided to
also depends on YOU. to improve both her
move back to the United
functional ability and her
Meet Elvira. Elvira was 40 States so that she could
capacity to live and work
years old and living in rural get the rehabilitaiton serv-
independently again.
Costa Rica when she cies she needed. She would
awoke one night with an also be closer to family and Today, nine years after her
upset stomach and stinging friends to get the emotion- stroke in another county,
pain shooting down her al support that she was Elvira is able to receive
left arm, coupled with arm lacking in her recovery. weekly therapy. She has
cramps. When she tried been working full-time as
Once back in the states,
to get up, she found that an Administrative Assistant
Elviras first doctor told her
she couldnt stand. She for over a year, and com-
that she was never going to
immediately called for mutes to and from work
walk again. She knew that
an ambulance, and after via public transportation.
he was wrong and was
arriving at the hospital, the As she says, You would be
determined to prove it.
doctors told her she had a surprised at how fast you
Elvira believed she would
stroke. Elvira was kept in can recover after finding
indeed, walk again. She
that hospital for 6 months, the right treatment and
found a rehabilitation team
receiving very little rehabili- believing in youself that
that provided her with the
tation and not making very you can improve.
services and treatment she

home, at work, and in the community. can make in your home to increase your
independence. These changes might
The rehabilitation process takes time and
include putting in ramps, changing door-
requires patience, motivation, and hard
knobs, widening doorways, and
work. To have a successful rehabilitation
moving furniture and rugs.
experience, you will need to relearn some
old skills, such as how to get around, While you are in a rehabilitation
and you will need to learn some program, you might feel limited
new skills as well. because you cant do
everything you did
The primary aim of
before your injury or ill-
medical rehabilitation is
ness. With persistence
for you to be able to do
and the help of family,
activities of daily liv-
friends, doctors, ther-
ing, such as eating, dress-
apists, nurses, and
ing, and bathing, so that you
other rehabilitation
can live as independently as
experts, you will be able to
possible. Rehabilitation works to
regain some of the functional
reduce the limitations you may experi-
ability you had before. You will also learn
ence with certain activities. For example, if
new ways to do tasks and take part in
you cannot walk on your own, physical
activities on your own.
therapy will help improve your balance
and muscle strength.
WHO WILL I WORK WITH
You might also be given assistive equip- DURING REHABILITATION?
ment. This would include items such as a During rehabilitation, you will most likely
cane, walker, brace, or wheelchair. All of work with several different rehabilitation
these will help to increase your independ- professionals. These professionals make up
ence. This equipment will also help you to your rehabilitation team. The members of
function better, get around on your own, your team will depend on your needs, your
and make your life easier. current insurance coverage, and the type of
Rehabilitation will also help you find ways rehabilitation program you choose.
to cope with the barriers of your physical Following is a list of some of the people that
environment. For example, you may learn you might work with; some of them might
how to go up and down ramps, get through be familiar to you. Regardless, full defini-
doors, and use public transportation. tions and descriptions of all of these profes-
sionals are included in the Terms section
You might also learn about changes you at the back of this guidebook.

Audiologist Prosthetist
Chaplain Rehabilitation case manager
Clinical neuropsychologist Rehabilitation engineer
Clinical psychologist Rehabilitation nurse
Dietician Respiratory therapist
Occupational therapist Social worker
Orthotist Speech-language therapist
Physiatrist Therapeutic recreation specialist
Physical therapist Vocational rehabilitation specialist
POINTS TO REMEMBER FROM THIS SECTION

Rehabilitation will help you regain your functional ability. This may involve relearning
old skills and learning some new skills.
During rehabilitation, you will work with many different rehabilitation professionals.
The members of your rehabilitation team will depend on your needs, your insurance
coverage, and the type of program you have chosen.

PART 2:
Health
Insurance Plans
HEALTH INSURANCE PLANS

PART 2:
Health
Insurance Plans
T
he rehabilitation programs that you will also depend on whether you currently
can choose from will depend on, in have a private insurance plan or a public
part, what services your current insurance plan. Following, the differences
health insurance plan will cover. It is are described.
important to know and understand the
type of insurance coverage you have so WHAT ARE SOME DIFFERENT TYPES
youll know what type and amount of OF HEALTH INSURANCE PLANS?
rehabilitation services you can receive. For There are two general types of private
example, if you are a veteran, you might be health insurance plans, traditional insur-
eligible for rehabilitation services through ance plans and managed care plans, and
the Department of Veterans Affairs. two types of public plans, Medicare and
Medicaid. Over time, the differences
WHAT REHABILITATION PROGRAMS between these two types of plans have
AND SERVICES WILL MY HEALTH
become less and less clear. Today, many
INSURANCE COVER?
traditional plans have managed care fea-
When selecting a health insurance plan, tures. Many managed care plans also have
make sure to select a plan that covers features of traditional plans.
rehabilitation services, for the type of reha-
Traditional health insurance plans are
bilitation services you can choose will
sometimes referred to as fee-for-service
depend largely on the type of health insur-
plans. Usually, such plans only pay a por-
ance coverage you have. Your health
tion of your yearly health care expenses
insurance coverage can limit your choice
after you have paid a set amount of money
of rehabilitation services, providers, and
toward all the health care services you
facilities. It is important to understand
receive. This set amount of money (such
your health plan so you can make
as $250) is called the yearly deductible,
informed decisions about your care.
and you pay for this amount out of your
Keep in mind that all health insurance own pocket.
plans are not alike. They vary from state to
For example, your traditional health insur-
state and from person to person. Your
ance plan might pay for 80% of all your
plans coverage for rehabilitation services
health care expenses after you have paid

your yearly $250 deductible. After you type of managed care plan.
have paid the $250 out of pocket, you
With managed care plans, most of the fees
would only pay 20% of the cost of your
that you would pay for services you
next service. Your health plan would then
receive are fully covered. But each time
pay for the remaining 80% of the cost.
you use a service, you must pay a small
Traditional health plans generally offer co-payment amount instead, as opposed
more flexibility than managed care plans. to the actual fee for the health care serv-
With a traditional plan, you likely will have ice. This co-payment can range from $5 to
more choices in terms of where to go for $50 or more, depending on the service.
rehabilitation, how much care you can
With managed care plans, you generally
receive, and which doctors you can
dont have to pay a yearly deductible
see. Some traditional plans dont
amount before the health insurance starts
limit the number of rehabilitation
to pay a percentage of your cost.
services
Instead, all of the cost of the
y o u
service is covered after
receive.
you pay the small
This is dif-
co-payment
ferent than
amount at each
managed
visit.
care plans,
which usually limit The downside of man-
the number of rehabilita- aged care plans is that your
tion visits that will be covered. choice of doctors and health care facilities
is limited. You often must choose from
Managed care plans are the other com-
only doctors who participate in the plan.
mon type of health insurance plans. With
Also, the plan may limit the amount of cer-
this type of plan, all health care services
tain health care services, such as rehabili-
are delivered at a reduced price to plan
tation services, you can receive.
members who agree to only get their
health care from certain doctors at certain Remember that not all health care plans
locations. With managed care plans, a are alike. Be sure to check with your health
doctor known as a primary care doctor plan provider before making any decisions
manages your care. You usually have to about your rehabilitation program. No
see your primary care doctor first, and matter what type of health insurance plan
then he or she can refer you to other you have, find out which services will be
providers you might need to see. A health covered and how many services you can
maintenance organization (HMO) is a receive.

Whats the difference between What does Medicare cover?

private and public health If you are 65 or older, or under 65 and have
insurance payers? a disability, and if you meet certain require-
There are two types of health insurance ments, part of your health care likely is paid
payersprivate and public payers. Private for by the federal Medicare program.
payers typically are employers. If you
Medicare is made up of Parts A, B, C
have health coverage through your
(Medicare Managed Care) and D. Medicare
employer, then your health care services
Part A covers:
are covered by a private payer.
All inpatient hospital expenses,
Public payers are the government
Medicare and Medicaid programs. They Certain services provided in a hospice
cover your health and rehabilitation service or skilled nursing facility, and
needs if you meet certain requirements.
Certain services provided through home
The Medicare program is run by the federal health care services.
government and provides health care cov-
Medicare Part B is optional coverage that
erage mainly for people with disabilities
can be purchased and paid for each
and those who are over the age of 65. The
month. This insurance covers:
Medicaid program is run by state govern-
ments and provides coverage mainly for Doctors and outpatient hospital services,
people with low incomes and those with
Physical and occupational therapy,
certain disabilities. Because the Medicaid
program is run by the individual states, cov- Certain medical equipment, and
erage varies from state to state. Each state Some home health services.
sets its own rules for who is eligible for cov-
erage and what services are covered. Medicare can have features of both tradi-

tional and managed care insurance plans. health insurance coverage for low-income
For example, Medicare Part C, as it is com- people of any age. It also covers persons
monly referred to, includes Medicare with certain kinds of disabilities. In gener-
Managed Care plans (Medicare + Choice). al, Medicaid covers:
Introduced in 1997, Medicare Managed
Hospital care,
Care plans offer expanded benefits, for a
fee, through HMOs that contract with Doctors services,
Medicare. In 2004, Medicare + Choice was
Nursing home care,
replaced by Medicare Advantage.
Home health care,
Mecicare Part D is the new prescription
drug coverage, which becomes fully effec- Outpatient services, and
tive in 2006. This prescription drug benefit
Prescription drugs.
is optional and coverage, deductibles, co-
payments, and out-of-pocket costs will vary In some cases and depending on your
depending on both your personal income income, Medicaid can also help to pay for
and total prescription drug expenses. some of the Medicare expenses (such as
deductibles and co-payments) mentioned
Make sure to find out about coverage limi-
above.
tations under your Medicare plan, because
Medicare has rules about the services and Medicaid rules, eligibility, and coverage
treatments covered. For example, depend- differ from state to state. Make sure to
ing on your Medicare coverage, you may check with your state Medicaid office to
have to pay for a portion of the health care find out your states eligibility require-
services you receive. You also may have to ments and what rehabilitation services are
pay either a yearly deductible or co-pay- covered.
ments for certain services. To learn more about Medicare and
Medicaid, visit the federal Centers for
What does Medicaid cover? Medicare and Medicaid Services Web site
The state-run Medicaid program provides at: http://www.cms.gov.
POINTS TO REMEMBER FROM THIS SECTION:

Know your health insurance plan when making choices about rehabilitation services.
There are two kinds of private health insurance plans: traditional (fee-for-service) and
managed care. Each type of plan has different characteristics.
Private payers of health insurance are typically your employer. Public payers are the
federal and state governments (Medicare and Medicaid).

PART 3:
Choosing a
Rehabilitation Program
CHOOSING A REHABILITATION PROGRAM

PART 3:
Choosing a
Rehabilitation
Program
Now that you know what rehabilitation is, Subacute rehabilitation,
what it can do for you, and what your cur-
Day rehabilitation,
rent insurance plan may cover, the next
step is to understand the different types of Home care,
rehabilitation programs available.
Outpatient rehabilitation, and
HOW DO REHABILITATION Nursing home rehabilitation.

PROGRAMS DIFFER?
Acute rehabilitation programs provide
Programs differ from one another in terms both medical care and a full range of reha-
of: bilitation services. These services include
physical therapy (PT), occupational thera-
The types of rehabilitation services
py (OT), rehabilitation nursing, speech-
they provide,
language therapy (SLT), vocational reha-
How often the services are provided, bilitation (VR), and therapeutic recreation
The physical setting where these (TR). Other services may also be offered.
services are provided, and In an acute rehabilitation program, a team
Who provides the services. designs a personalized, interdisciplinary

rehabilitation program to meet your needs.
When choosing a program, find out if the Doctors are in direct contact with you
services you need will be offered often (usually daily, but no less than 3 times a
enough and whether your treatment will week) to monitor your medical condition
be supervised by a rehabilitation doctor or and progress. In an acute rehabilitation
other rehabilitation professional. Also find facility, you would also receive 24-hour
out if the programs services are covered nursing care.
by your health insurance plan.
If you have complex medical needs and
Several different kinds of rehabilitation could develop complications if your medical
programs are available. They include: treatment is not continued, an acute reha-
Acute rehabilitation, bilitation program is best for you. To take

T YPES OF REHABILITATION PROGRAMS

Amount of
Program Where Services Rehabilitation Nursing Rehabilitation
Type are Provided Services Offered Care Offered Therapy Provided
Acute At an acute Medical care, physical 24-hour At least 3 hours

rehabilitation rehabilitation therapy, occupational nursing care of therapy a day,
facility located in therapy, speech-language at least 5 days
a freestanding therapy, vocational a week
rehabilitation rehabilitation, therapeutic
hospital, or a recreation, psychological
rehabilitation unit services, and other
in an acute care services as needed
hospital
Subacute At a subacute Medical care, physical 24-hour 1 to 3 hours
rehabilitation rehabilitation therapy, occupational nursing care of therapy a day,
facility or unit, or therapy, speech-language 1 to 6 days
in a skilled therapy, therapeutic a week
nursing unit recreation, psychological
services and other services
as needed
Home care At home Physical therapy, As needed, 1 to 2 hours
occupational therapy, and 1 to 7 days of therapy a day,
speech-language therapy a week 1 to 3 days a week
Day At hospital-based Physical therapy, Depending on 3 to 5 hours
rehabilitation outpatient clinics occupational therapy, program and of therapy a day,
or free-standing speech-language therapy, individual 3 to 5 days a week
outpatient clinics therapeutic recreation, needs
and psychological services
Outpatient At an outpatient Physical therapy, None 1to 3 hours
rehabilitation facility, such as occupational therapy, of therapy a day,
hospital-based speech-language therapy, 2 to 3 days a week
outpatient clinics vocational rehabilitation,
or free-standing and psychological services
outpatient clinics
Nursing home At a nursing Depending on the 24-hour 1 to 3 days a week,
rehabilitation home nursing home, various nursing care depending on the
rehabilitation services individuals needs
may or may not be
provided

part in such a program, you must be able to therapy given in an acute rehabilitation
tolerate at least 3 hours of rehabilitation program. Subacute rehabilita-
therapy per day, at least 5 days a week. tion also requires that you are
in stable medical condition
Acute rehabilitation
and need continued medical
programs can be
care to avoid possible com-
found in freestand-
plications. For subacute
ing rehabilitation
rehabilitation, you must
hospitals. These
be able to tolerate 1 to 3
hospitals are dedi-
hours of therapy per day, 1
cated solely to
to 6 days per week.
rehabilitation. You
will also find acute Subacute rehabilitation is
rehabilitation pro- offered in many different
grams in acute settings, including:
care hospitals that have specialized reha-
Freestanding, subacute rehabilitation
bilitation units.
facilities that provide medical rehabilita-
Subacute rehabilitation programs often tion only;
provide therapy needed before or after you
Subacute rehabilitation units that are a
complete acute rehabilitation but before
part of general, acute care hospitals;
you go home. A fairly wide range of reha-
bilitation services, including PT, OT, SLT, Skilled nursing units that are a part of
and TR, is provided. Subacute rehabilita- general, acute care hospitals; and
tion is less intensive and generally lasts
Skilled nursing beds that are located in
longer than acute rehabilitation.
nursing homes.
A subacute rehabilitation program
A skilled nursing facility (SNF) is one
includes 24-hour nursing care, and your
place you might receive subacute rehabili-
treatment plan is supervised by a rehabili-
tation. SNFs meet certain industry stan-
tation doctor. The rehabilitation doctor
dards and offer a higher level of nursing
also provides additional health care as
care than that offered by nursing homes.
needed. However, you will see the rehabil-
itation doctor less often than you would in Day rehabilitation, or day treatment,
an acute rehabilitation program. programs are like acute rehabilitation pro-
grams except that patients do not stay
Subacute rehabilitation is best for you if
overnight in a hospital. You can live at
you have a high level of disability but can-
home or in another community setting.
not tolerate the amount or intensity of

These programs offer many rehabilitation therapy). Additional nursing care is not
services, which are supervised by rehabili- provided. Typically, you receive outpatient
tation doctors. Nursing care and general rehabilitation therapy services 2 to 3 days
medical care are also offered as needed. per week.
If you are medically stable and dont need If you are in a medically stable condition
intensive nursing care or constant monitor- and are able to live in your own home
ing by a doctor, a day rehabilitation pro- without the risk of developing complica-
gram is best for you. These programs pro- tions, outpatient rehabilitation is best for
vide 3 to 5 hours of therapy per day, 3 to 5 you. Outpatient rehabilitation therapy
days per week. Day rehabilitation programs services are often given to continue treat-
can be independent freestanding programs, ment after more intensive acute or suba-
or part of rehabilitation hospitals. cute rehabilitation.
Home health care services allow you to Outpatient rehabilitation therapy services
receive rehabilitation treatment in your are provided in many different settings,
own home. Home health care would be including doctors offices, hospital-based
right for you if you are able to live at home outpatient units, hospital-owned outpa-
but are not able to travel to an outpatient tient centers, and other outpatient centers
facility if your health does not allow it, you that are not a part of hospitals.
live too far away, or you do not have trans-
A nursing home is another setting where
portation.
you might receive rehabilitation services.
With home health care services, rehabilita- Nursing homes are different from skilled
tion professionals travel to your home to nursing facilities because not all nursing
provide rehabilitation services and nursing homes provide rehabilitation services for
care. Services and care are provided as their residents.
often as your doctor prescribes them and
The kinds of rehabilitation services offered
your insurance allows. You typically
and the intensity of the rehabilitation treat-
receive 1 to 2 hours of therapy per day, 1 to
ment vary from one nursing home to
3 days per week.
another. Some nursing homes provide
Outpatient rehabilitation is provided if rehabilitation treatment 1 to 3 days per
you live at home and can travel to an out- week. Treatment can be a single rehabili-
patient facility. Outpatient rehabilitation tation therapy service, such as physical
can include a full range of therapy services therapy. It can also be offered as a coordi-
that make up a coordinated program of nated program of care that includes sever-
care. It can also include only one or two al different services.
services (such as physical or occupational

If you are medically stable but have special nently or for a period of time.
needs that require 24-hour nursing care, a
Nursing homes differ greatly in the care
nursing home is a good choice. You might
they provide, so it is very important to ask
want to consider a nursing home if you
many questions when you are choosing
need ongoing nursing care and cannot be
this type of care. Make sure to ask about
cared for safely at home, either perma-
LOLAS STORY: FINDING A QUALITY REHABILITATION PROGRAM FOR YOUR NEEDS

Lola was 32 when she was grams. They then gathered Having all of this informa-
hit by a car as she was information to help decide tion helped Lola and her
crossing the street. Her which of the remaining husband choose a high-
left leg was shattered and programs would offer the quality rehabilitation
her left hip broken. After best quality of care to meet program. They felt that
many surgeries and weeks Lolas needs. the program they chose
in an acute care hospital, would best help Lola
To begin, they looked on
Lola went to an acute reach her goal of living as
the CARF website to find
rehabilitation facility, independently as possible
out which nearby rehabili-
where she was an inpatient in her own home.
tation programs were
for a short time.
accredited. They called After going home from the
She and her husband had those programs to ask acute rehabilitation facility,
to start thinking about about the FIM scores of Lola continued to work
which rehabilitation pro- discharged patients. toward her recovery goals.
grams would best meet her With months of home and
In addition, they asked
long-term recovery needs outpatient therapy, she
what percentage of previ-
after she was discharged noticed a gradual, yet
ous patients went home,
from the acute rehabilita- marked improvement in
rather than to nursing
tion facility. This involved her walking ability.
homes or assisted living
learning about the different
centers when discharged. By the time she finished
outpatient programs
They also wanted to know outpatient therapy, she
offered in their area.
how satisfied other felt that she had made
Lola had a private health patients were with the the right decisions when
insurance plan offered program and facility. To choosing her therapy
through her employer. find out, they asked about programs. Despite her
Because of the plans cov- the results of any of the disability, she was well on
erage limits, she and her programs patient and her way back to her active,
husband had to rule out family satisfaction surveys. independent lifestyle.
certain rehabilitation pro-

the kinds of rehabilitation services that are skills, you could then get to the rehabilita-
offered, how often the services are provid- tion facility for outpatient care.
ed, and what types of rehabilitation profes-
Subacute rehabilitation can also be a
sionals provide care in the nursing home.
bridge between your discharge from an
acute care hospital and the beginning of
Will I need more than one
another rehabilitation program. Subacute
kind of program?
care might be helpful if you need time to
During the course of your rehabilitation, increase your endurance and tolerance for
you may need and receive care in more rehabilitation before starting another pro-
than one program or setting. Depending gram.
on how your medical condition and reha-
Moving from one treatment program or
bilitation needs change, you might be
setting to another is common. Doing so
moved to a different program or treatment
helps make sure that you receive the kind
setting. One program may serve as a
and amount of rehabilitation services you
bridge to another.
need, when you need them.
For example, home health care can be
Keep in mind that there is no right way to
used as a bridge between the acute care
progress through rehabilitation. Each per-
hospital and an outpatient rehabilitation
son has different needs that are met by dif-
program. During home care, you might
ferent kinds of rehabilitation at various
learn certain skills, such as how to man-
points in time.
age stairs in front of your home and how to
get in and out of a car. After learning those

There are many different types of rehabilitation programs offered in different
rehabilitation settings.
The type of program you choose should depend on both your rehabilitation needs and
your health insurance coverage.
You may progress through more than one type of rehabilitation program during your
recovery.

PART 4:
Quality and
Rehabilitation
QUALITY AND REHABILITATION

PART 4: Reports to compare the cost, reliability, and

special features of different models. You
can then choose a high-quality, affordable
Quality and TV that has the features you want.
Rehabilitation In the same way, when you are looking for
Its also a good idea to try to find out about a rehabilitation program, you can compare
the quality of rehabilitation services when the quality and services of different pro-
you choose where to go for rehabilitation. grams to help you decide how well they
The following section will help you to fig- meet your own needs. One way to do this
ure out what to look for in a high-quality is to compare different rehabilitation hos-
rehabilitation program. It also describes pitals. For example, U.S. News & World
some of the ways to measure quality. With Report magazine publishes yearly ratings
this information, you will be able to com- of Americas best
pare the rehabilitation programs and hospitals,
services that you are choosing from. including

rehabilita-
WHAT IS MEANT BY QUALITY? tion hospitals.
In health care, quality refers to You can also contact

how well health care services different rehabilitation
meet an individuals programs to ask questions
needs. Some pro- and make your own compar-
grams and facil- isons about their services and quality of
ities do a bet- care. The checklists at the back of this
ter job of this guidebook suggest some questions to ask
than others. when looking for a high-quality rehabilita-
When choos- tion program. In addition, the information
ing health care below should help you understand what to
services, you can compare the quality of think about and look for when comparing
services provided by different programs to the quality of rehabilitation programs.
help you decide which one will best meet
your needs. WHAT ARE REHABILITATION OUTCOMES?
In some ways, comparing health care One way to find out about the quality of
providers is like comparing products you rehabilitation services is to look at rehabil-
can buy. For instance, if you want to buy a itation outcomes. In general, the outcome
new television set, you can read Consumer of an event is the end result of that event.
For example, the outcome of an event

such as a football game would be the final rehabilitation outcomes such as these, you
score. The score reflects the fact that one can compare services and programs and
team did better than the other. decide which one is best for you.
In the rehabilitation setting, outcomes Information about rehabilitation outcomes

refer to certain scores, or pieces of infor- is collected in many different ways and
mation that tell you how good a certain about many different topics. Information
service, treatment, or rehabilitation pro- can be collected about just one person, or
gram is. For example, after treatment, can it can be collected about the rehabilitation
you walk without help? Do you have less organization or program as a whole. All of
pain? Walking without help and having this information will help you to figure out
less pain are possible positive outcomes of how good the services are and if the pro-
rehabilitation treatment. By looking at gram is of high quality.
MORE ABOUT When measured at patients and families, based

OUTCOMES admission and discharge, on any available survey
a patients FIM score can results?
OUTCOMES may be a range from 18 to 126. A
term that you have not The higher the satisfaction
higher average change in
heard of before. Outcomes levels of patients and fami-
FIM score at discharge is
are the impact of the lies, the better. Ask to see
better. For example, an
rehabilitation care and any results from the pro-
overall change of 20 points
treatment provided to grams patient and family
at discharge is better than
a patient. satisfaction surveys, includ-
an overall change of 10
ing results for your specific
When youre choosing points.
condition.
a rehabilitation program,
ASK: What percentage of
be sure to ask about the ASK: What percentage of the
the programs inpatients are
programs outcomes. programs inpatients go back
discharged to the community,
Below are some examples to a hospital or other inpatient
rather than to nursing homes?
of questions for you to ask, health care facility within 15
and what to look for in the The higher the percentage days of discharge from the
answers you may receive: of patients who return to rehabilitation program?
their community, the better.
ASK: What is the average The lower the percentage
For example, 85% of
change in FIM scores for of people readmitted to a
inpatients returning to
patients discharged from hospital or other inpatient
their community is better
your program? facility, the better. For
than 65%.
example, 5% of a pro-
FIM scores measure grams patients going back
ASK: How satisfied with the
patients changes in func- to inpatient care is better
program were previous
tion during rehabilitation. than 25%.

WHAT ARE SOME WAYS QUALITY IS home and to their communities when
MEASURED AT THE INDIVIDUAL LEVEL? they leave the program, and
In an acute, inpatient rehabilitation Patients and family members satisfac-

setting, the quality of services can be tion with the program.
measured by looking at certain individual
Changes in functional ability. A change
outcomes. For instance, most rehabilita-
in functional ability is one way to look at
tion providers collect information about
how effective the services are in restoring
the functional ability of their inpatients, as
and improving function and meeting reha-
well as their ability to meet key, functional
bilitation goals.
goals. This information often is collected
twice-once at admission and again at dis- When you are first admitted to an acute,
charge. Any changes in functional ability inpatient rehabilitation facility, your reha-
can then be measured, recorded, and com- bilitation team will collect information on
pared with other programs' outcomes. how well you are functioning. For exam-
ple, the team may measure your ability to
When choosing a rehabilitation program,
walk or groom yourself independently. The
you can look at some of the programs
team will then compare this information
individual outcome measures and then
with how well you are functioning when
compare them with those of other pro-
you leave the facility. The ideal outcome,
grams. Following are three individual out-
or end result, would be that your level of
comes that you can look at:
functioning and independence increased
Patients changes in functional ability, after your stay in the rehabilitation setting.
The percentage of patients who return Your level of functioning will probably be
MORE ABOUT discharge shows how much interactions, problem

THE FIM patients function has solving, and memory.
improved overall during
The FIM, or Functional Each of the 18 items can
their stay.
Independence Measure, is be scored from one to
the most widely used func- The FIM tool includes seven. The overall FIM
tional measurement tool in 18 items about self-care score for the entire
medical rehabilitation. The (grooming, eating, bathing, questionnaire can therefore
functioning of inpatients is and dressing), sphincter range from 18 to 126. A
usually measured at admis- (bowel and bladder) con- higher overall score means
sion to a rehabilitation set- trol, and mobility and that the person is more
ting, and then again at dis- walking. Other items ask independent. A lower over-
charge. The change found about comprehension, all score means that the
between admission and understanding, social person is more dependent.

measured through what is called the FIM, home and community, and patient satis-
or Functional Independence Measure. The faction, you can get an idea of how good a
FIM is a measurement tool with 18 items rehabilitation programs services are (See
that look at how well you do certain activ- More About Outcomes box).
ities while in acute inpatient rehabilitation.
(See More about the FIM box). WHAT ARE SOME WAYS
QUALITY IS MEASURED AT THE
Return to community. Another outcome to ORGANIZATIONAL LEVEL?
consider is the percentage of individuals
The measures described above will help
who return to their communities (rather than
you learn about the quality of care provid-
to nursing homes, for example) after inpa-
ed to individuals who have been in a reha-
tient rehabilitation. This would mean that
bilitation program. They will help to
they are functioning well enough on their
answer questions such as: Do inpatients
own to not need assistance with daily living.
have functional improvements? Are they
Satisfaction. Patients and their family able to go home after rehabilitation? Are
members satisfaction is another outcome they satisfied with their care?
to think about. Many rehabilitation facili-
All of those are important questions to ask.
ties and programs ask inpatients to fill out
But there are also many other ways to look
a satisfaction survey and to rate their care.
at quality on a broader, more general level
By asking about FIM scores, return to as well. For example, you can ask about:
MEASURING OUTCOMES

The qualifications of the rehabilitation and certified in a specialty such as physical

team members, medicine and rehabilitation or neurology.
The rehabilitation teams experience A programs other rehabilitation team

and success with your condition, and members should also be trained and
skilled in their fields. For instance, team
The organizations or programs accred-
members should have degrees and cre-
itation status.
dentials in physical therapy, occupational
Qualifications of the team. Rehabilitation therapy, or speech-language pathology.
team members who are qualified to treat
Experience and success with your
you should have rehabilitation training and
condition. The rehabilitation program you
experience in their fields. For example, the
choose should have a good record of treat-
team should include a doctor who is trained
ing patients with your disability or condi-
MORE ABOUT certain performance stan- CARF, the Rehabilitation

JCAHO AND CARF dards. JCAHO reviews and Accreditation Commission,
ACCREDITATION accredits different kinds of accredits only medical
health care organizations rehabilitation services and
Accrediting bodies make and programs, including programs in the Health
sure that health care rehabilitation programs. Care Division.
organizations are of high
quality and standards. JCAHO has three levels of If a rehabilitation program
Accreditation refers to a accreditation scores. These or facility is accredited by
status given to hospitals levels are Not Accredited, CARF, its rehabilitation
and other health care facil- Conditional Accreditation, services are of the highest
ities that meet certain and Full Accreditation. standards and quality.
standards of excellence Fewer JCAHO recommenda- CARF may also recommend
and quality. Hospital, facil- tions to improve the quality Non-Accreditation,
ity, and program quality is of their care reflect better Conditional Accreditation,
assessed by a panel of outcomes. or a 1 or 3 year accredita-
experts who follow an tion period.
JCAHO accreditation
approved review process. results, or the status of To find CARF-accredited
JCAHO and CARF are two health care organizations, rehabilitation programs for
major accrediting bodies. can be obtained and com- your condition in a partic-
JCAHO is the Joint Com- pared using the JCAHO ular state, visit the CARF
mission on Accreditation of website: website and search under
Healthcare Organizations. the link Search for a
http://www.jcaho.org/
This group looks at how Provider:
qualitycheck/directry/
well health care organiza- http://www.carf.org
directry.asp
tions and programs meet

tion. Some facilities provide a wide range JCAHO is the Joint Commission on
of rehabilitation services for conditions, Accreditation of Healthcare Organizations.
such as stroke rehabilitation, brain injury, It is an independent, non-profit organiza-
multiple sclerosis, and hip replacement. tion that looks at how well health care
Others programs may offer expert care in providers meet quality and performance
only one area, such as hand or spinal cord standards. JCAHO looks at the quality of
injury rehabilitation. the staff and equipment, as well as the
organizations success in treating patients.
It is important to find out which rehabilita-
An organization, hospital, or program is
tion programs provide the specialized care
accredited only if these standards are met.
you need. If one is not available in your
area, you might want to consider going to CARF, the Rehabilitation Accreditation
another area or state for rehabilitation. Commission, is another independent, non-
profit group that helps to ensure high-quality
Accreditation status. Another way to find
care and the best possible outcomes. CARFs
out about the general quality of a rehabili-
Health Care Division only reviews and
tation program, organization, or facility is
accredits medical rehabilitation services and
to look at its accreditation status.
programs. These services and programs may
Accreditation is like a seal of approval
be offered in an inpatient hospital, an outpa-
given to hospitals and both health care
tient clinic, or in a workplace or other com-
facilities. Accredited organizations and
munity setting. CARF accreditation means
programs meet high standards of excel-
that the services that a program provides
lence in service and quality.
meet high standards of quality.
Two accrediting groups you may hear of
If you know how to look at quality and out-
are JCAHO and CARF. If a rehabilitation
comes at both the individual and organiza-
facility, program, or health care organiza-
tional levels, you will be better prepared to
tion is accredited by both of these organi-
choose a high-quality rehabilitation facility
zations, you can feel confident that it will
or program that will best meet your needs.
provide high-quality care. (See More about
Part 3 of this guidebook offers more advice
JCAHO and CARF Accreditation box).
for choosing a rehabilitation program.

One way to know about rehabilitation quality is to look at a programs outcomes.
Individual outcomes you can look at include FIM scores, where patients are
discharged to, and patients and families satisfaction with the program.
Organizational outcomes you can look at include a rehabilitation programs
accreditation status given by JCAHO and CARF.

STEPS FOR CHOOSING A HIGH-QUALITY REHABILITATION PROGRAM


TERMS
Terms
Terms or she will make recommendations

about the need for hearing aids or other
Accreditation (p.22): An objective assistive hearing devices.
evaluation process that determines
Capacity (p.3): A persons ability to
if hospitals and other health care
do a task or activity in a controlled
organizations meet certain high
environment or place, free of any
standards of excellence, service,
external barriers.
and quality in their field. Think of
accreditation as a seal of approval. Chaplain: A hospital chaplain is available
in the hospital 24 hours a day, and is
Activities of daily living (ADL) (p.5):
able to provide crisis intervention and
Routine activities a person does every
spiritual support for you and your family.
day, such as standing, sitting, walking,
eating, bathing, and grooming. Clinical neuropsychologist: A psychol-
ogist who specializes in studying brain
Acute care hospital (p.3): A hospital
behavior relationships. Neuropsycholo-
that provides acute medical care.
gists treat people who may have some-
Acute medical care (p.3): Medical care thing wrong with the way that their
that is meant to stabilize ones short- nervous system (the brain and spine)
term medical condition and minimize functions.
complications; usually received before
Clinical psychologist: A mental health
rehabilitation.
professional who can help people
Acute rehabilitation (p.11): Medical understand and adjust to disability. He
services that include both medical or she will teach coping skills, such as
care and other rehabilitation services, stress management and pain control,
such as physical therapy, occupational and will offer individual, family, or
therapy, and speech-language therapy. group counseling.
Assistive equipment (p.5): Any equip- CARF, the Rehabilitation

ment or device, such as a wheelchair, Accreditation Commission (p.22): An
brace, walker, or speech aid, that helps independent, non-profit body that helps
a person become more independent, to ensure high-quality and the best pos-
function better, and perform activities sible outcomes in rehabilitation services
of daily living. and programs. A rehabilitation program
accredited by CARF means that the
Audiologist: A health care professional
services provided are of the highest
who uses advanced equipment to evalu-
standards and quality.
ate and diagnose hearing problems. He

Co-payment (p.8): In a managed care inpatient rehabilitation. The FIM meas-

plan, a small, fixed dollar amount that ures a persons ability to perform the
you must pay before you receive a following independently: self-care,
health care service. Depending on the sphincter (bowel and bladder) control,
plan and the health care service you are transfers, locomotion, communication,
receiving, a co-payment can range from and social cognition.
$5 to $50 or more.
Health maintenance organization
Day rehabilitation (day treatment) (HMO) (p.8): A type of managed
(p.13): Rehabilitation care that provides care plan in which people can only see
a full range of intensive rehabilitation doctors who are a part of their HMO
services, but allows patients to stay at network of providers. Referrals from a
home overnight. primary care doctor are needed in order
to see specialists or to get other health
Deductible (p.7): A yearly dollar amount
care services within the network.
that the patient must pay before an
insurance company begins paying for Home health care (p.14): Health care
any services. This amount varies services provided in your home by a vis-
by insurance plan. iting health care professional, such as a
nurse or therapist.
Dietician: A professional who designs
a dietary plan that meets your personal Inpatient rehabilitation (p.19):
nutritional needs. The dietician will take Rehabilitation services received as an
into account your food preferences, inpatient in a rehabilitation unit or a free-
your physical abilities, and any dietary standing rehabilitation hospital setting.
recommendations from your doctor.
Joint Commission on Accreditation of
Disability (p.3): An impairment, Healthcare Organizations (JCAHO)
limitation in activities, or restriction (p.22): An independent, non-profit
in participation. organization that evaluates how well
health care organizations and programs
Functional ability (p.3): How well a
(including rehabilitation programs)
person is able to perform daily activities
meet rigorous quality and performance
(such as eating, bathing, dressing, and
standards.
communicating) without help from
someone else. Managed care (p.8): Health insurance
plans that deliver comprehensive health
Functional Independence Measure
care services at a reduced price for
(FIM) (p.19): A measurement tool that
members who agree to use certain
uses 18 items to assess progress during
providers and facilities.

Medicaid (p.9): A state government-run Outcomes (p.17): The impact of care

program that provides health insurance and treatment provided to a patient.
mainly for low-income families and In the rehabilitation setting, one way
people with significant disabilities. to measure this impact is to collect
information about the patient regarding
Medical rehabilitation (see rehabilita-
functional abilities at admission and
tion) (p.3).
then again at discharge. The services
Medicare (p.9): A health insurance delivered can be compared as to their
program administered by the federal effectiveness in restoring and improving
government that provides health function. Patient satisfaction measures
insurance for people age 65 or older, are also considered an outcome.
some people with disabilities, and
Outpatient rehabilitation (p.14):
others who qualify.
Rehabilitation services provided to a
Nursing home (p.14): A facility where person who lives at home. Outpatient
patients stay to receive rehabilitation rehabilitation may be a comprehensive,
services, long-term care, or skilled daily program of multiple services or
nursing care. only one or two services once or twice
a week.
Occupational therapy: Therapy that
teaches skills and adaptations to Performance (p.3): A persons ability to
improve ones ability to do tasks at do a certain task in his or her present
home, at work, and in the community. environment, which may include certain
The occupational therapist (OT) or barriers, such as steps or bad weather.
occupational therapy assistant will
Physiatrist: A physiatrist is a doctor
teach you skills and adaptations needed
who specializes in physical medicine
to improve your ability to do tasks at
and rehabilitation (see next term).
home, at work, and in the community.
Physiatrists are trained to assess your
Your OT practitioner will focus on pre-
level of functioning, diagnose your
venting, reducing, or adjusting to dis-
disability, and treat any medical
ability so that you can do a wide range
complications related to your disability.
of activities, from bathing to managing
Their goal is to maximize your function-
personal finances.
al ability, independence, and quality
Orthotist: A professional who helps of life. Your physiatrist will manage
make, fit, and repair adaptive devices, your rehabilitation team and will be
such as orthopedic braces (orthoses). responsible for medical decisions
about your care.

Physical medicine and rehabilitation states are the public payers of health
(PM&R): A medical specialty dedicated insurance programs such as Medicare
to diagnosing, treating, and preventing and Medicaid.
disability, and to improving patients
Quality (p.17): How well health care
functional ability, quality of life, and
services meet the unique needs of each
independence.
individual patient. Quality can be deter-
Physical therapy (p.5): Therapy that mined by asking, for example: Is the
restores and maximizes movement and patient satisfied with the health care
function. A physical therapist (PT) services? Is the health care organization
will evaluate how well you control responsive to each patients needs? Are
movement and your physical function- staff members qualified in their fields?
ing. He or she will do tests to see how Is the organization accredited?
much mobility, strength, and range of
Rehabilitation (also see medical rehabil-
motion you have. Your PT will then
itation) (p.3): Treatment received as part
design a treatment program to restore
of a program to enhance functional abil-
and maximize your movement and
ity following disease, illness, or injury.
function based on the test results.
Rehabilitation services can include, but
Primary care doctor (p.8): In a man- are not limited to, medical care, nursing
aged care plan, this is the doctor that care, physical therapy, occupational
manages your care. He or she can also therapy, speech-language therapy,
refer you to medical specialists or other therapeutic recreation, vocational
providers for additional health care that rehabilitation, counseling, and other
you may need. activities prescribed to increase a
patients independence and functional
Private payer (p.9): A non-governmental
abilities.
entity that pays for your health
insurance plan. Private payers typically Rehabilitation case manager: A health
are employers. care professional who makes sure that a
person receives needed services after a
Prothetist: A professional who helps
rehabilitation stay. A rehabilitation case
make, fit, and repair adaptive devices,
manager coordinates care across health
such as artificial limbs (prostheses).
care providers and facilities, and also
Public payer (p.9): The federal makes sure that all aspects of your
government or state that pays for treatment comply with the rules of your
a persons health insurance plan. insurance coverage.
The federal government and individual

Rehabilitation engineer: A specially community. A social worker will work

trained engineer who helps select, with you, your family, and community
modify, and design assistive equipment agencies to make arrangements for
for mobility, communication, work, support services that may be needed
recreation, and therapy needs. during and after rehabilitation. This
might include making referrals to
Rehabilitation nurse: The rehabilitation
community agencies; arranging for
nurse will work with other rehabilitation
continuing care; and offering counseling
professionals to personalize your care.
to you, your partner, and your family.
He or she will assist you with activities
of daily living and will help make your Speech-language pathology (some-
rehabilitation services a part of your times referred to as speech-language
daily hospital routine. The rehabilitation therapy): Therapy to restore and devel-
nurse will also teach you and your op communication skills and abilities. A
family about your disability, medica- speech-language pathologist (SLP)
tions, and treatment. will work with you to enhance your
communication skills if they have been
Rehabilitation team (p.5): A group of
affected by your illness or injury. This
health care professionals from different
may involve helping you to improve your
fields who work with the patient and
voice, speech, language, or conversa-
family to plan and provide rehabilitative
tional skills. It may also involve teaching
care.
you how to use gestures, computers, or
Respiratory therapist: A health care other devices to communicate. In addi-
professional who tests ones ability to tion, your SLP will help you to adapt to
breathe and designs a personalized any problems with swallowing or eating.
breathing program.
Subacute rehabilitation (p.13):
Skilled nursing facility (SNF) (p.13): Rehabilitation services that include
A facility that provides patients with a daily nursing services, supervision by a
high level of nursing care and meets rehabilitation doctor, and medical care
certain industry accreditation standards. as needed. Subacute rehabilitation is
less intensive and generally lasts longer
Social worker: A professional who pro-
than acute rehabilitation.
vides services to help with the transition
from an acute care setting to rehabilita-
tion, and then back to the family and

Therapeutic recreation: Therapy to Vocational rehabilitation: Services that

regain as much independence as possi- help to figure out a persons job
ble in ones leisure activities, pastimes, strengths, and provide guidance for
and hobbies. A therapeutic recreation employment or education planning. A
specialist will help you to evaluate vocational rehabilitation counselor
your leisure needs, abilities, and inter- will help to determine your job strengths
ests, and work with you to develop a and will provide guidance for employ-
treatment program. Therapeutic recre- ment or education planning. He or she
ation activities take place in both the will work with your current employer or
rehabilitation facility and the communi- school and will help to make sure that
ty. These activities are designed to help needed accommodations are made.
you regain as much independence as A vocational rehabilitation counselor
possible in your leisure pursuits. might also help you to look for new
employment and may talk with specific
Traditional health insurance (also
employers about your employment.
known as fee-for-service) (p.7): A type
In addition, he or she will coordinate
of health insurance plan in which a fee
referrals to community-based job
is charged for each health care service
service and vocational rehabilitation
received. The patient can freely choose
programs.
where to receive health care and
rehabilitation services. The insurance
plan covers a part of the cost of services
after a set deductible amount is paid.

QUALITY CHECKLISTS
Checklists
Quality
Quality Checklists
QUALITY CHECKLIST: MEETING YOUR PERSONAL NEEDS
Following are more examples of questions for you to ask as you look for a high-quality
rehabilitation program. These questions relate to what you personally want in a
rehabilitation program. These questions should be considered carefully, depending
on your personal needs.
Yes No
Is the location of the rehabilitation program convenient to

family members and friends who will visit you?
Are the visiting hours convenient for your family and friends?
Does the program ask patients and family members how satisfied
they are with the services and care they received?
If so, are the satisfaction data available?
Is the feedback positive?
Is the program covered by your health insurance plan?
If the program isnt covered by your health insurance plan,

will your plan cover any of the costs of the program?
OTHER QUESTIONS TO CONSIDER:

What is the programs average length of stay for people with your condition? ______ days
What percentage of people with your condition return to their homes after
being discharged (as opposed to being discharged to a nursing home)? ______ %
What is the overall patient satisfaction rating? ______ %

QUALITY CHECKLIST: MEETING INDUSTRY STANDARDS

Below are some examples of questions for you to ask as you look for a high-quality reha-
bilitation program that best meets your needs. These questions are based on quality stan-
dards within the rehabilitation industry.
Yes No
Is the program or hospital accredited by CARF?
Is the program or hospital accredited by JCAHO?
Is the program certified by Medicare? (Programs certified by Medicare

must meet minimum health and safety standards)
Has the program been in operation for at least 1 year?
Does the program have experience with your particular condition(s)?
Does the program have a system for checking both the clinical
progress of its patients and its own internal quality?
FOR ACUTE REHABILITATION AND DAY TREATMENT PROGRAMS:

Does the program offer at least 3 hours of therapy per day, 5 days a week?
Does the program offer services such as physical therapy, occupational

therapy, speech-language therapy, and psychology, depending on your
individual needs?
FOR SUBACUTE PROGRAMS:

Does the program offer at least 1 hour of therapy per day, 1 to 6 days a week?
Does the program offer services such as physical therapy, occupational

therapy, speech-language therapy, and psychology, depending on your
individual needs?

QUALITY CHECKLIST: MEETING STANDARDS OF EXCELLENCE

Following are more examples of questions for you to ask as you look for a high-quality
rehabilitation program. These questions are based on what makes an excellent rehabilita-
tion program.
Yes No
Does the program have a relationship with other programs that offer
rehabilitation services you may need at a later point in time (such as
subacute care, day treatment, outpatient treatment, or home care)?
Do the physicians who provide care in the program have a background

in rehabilitation medicine or a rehabilitation-related specialty,
such as neurology?
Does the program have a full-time physiatrist or rehabilitation specialist

available for patients?
Is your personal physician or primary care provider permitted to visit you

at this facility?
Does the program use a team approach, where the doctor, therapists,
and other rehabilitation professionals work together and meet at regular
intervals to talk about your progress?
Does the program hold family conferences to keep families involved

and informed of your progress?
Does the program conduct home visits to make recommendations before

discharging people who are returning home?
Does the program look at the progress of each patient by measuring his
or her functional ability and level of independence in doing daily activities?


Resources
RESOURCES
Resources American Academy of Physical

Medicine and Rehabilitation
Following is a list of resources. You may (AAPM&R)
find some of these to be useful as you http://www.aapmr.org/
gather information to help you to choose a 312-464-9700
quality rehabilitation program for your
AAPM&R is a professional organization for
specific needs.
physiatrists. Its Web site includes a search-
ABLEDATA able database that helps users to find
http://www.abledata.com/ physical medicine and rehabilitation spe-
800-227-0216 cialists who are members of AAPM&R.
TTY: 301-608-8912
American Congress of Rehabilitation
ABLEDATA is a federally funded project Medicine (ACRM)
that provides assistive technology infor- http://www.acrm.org
mation, including product descriptions, an 317-915-2250
online library, other disability-related
ACRM is a professional organization for
resources, and a consumer forum.
professionals who work in rehabilitation
Administration on Aging (AoA) fields. Its mission is to promote the art, sci-
U.S. Department of Health ence, and practice of rehabilitation care for
and Human Services people with disabilities. The ACRM Web
http://www.aoa.gov/ site includes resources and links to other
202-619-0724 organizations.
AoA is the federal focal point and advocate American Occupational Therapy
agency for older persons and their con- Association (AOTA)
cerns. It supports state and local commu- http://www.aota.org/
nity-based services, including home-deliv- 301-652-2682
ered meals, in-home assistance for elderly TTY: 800-377-8555
persons, transportation services, and
AOTA is a professional organization for
employment help.
occupational therapy professionals. Its
Web site provides consumers with general
information about occupational therapy;
tip sheets about health and disability
issues, conditions, and daily living;
resource listings; and a searchable directo-
ry of occupational therapy specialists.

American Physical Therapy Arthritis Foundation

Association (APTA) http://www.arthritis.org/
http://www.apta.org/ 800-283-7800
800-999-2782
The Arthritis Foundation is a national,
TTY: 703-683-6748
non-profit organization that provides
APTA offers consumers information about advocacy, programs, services, and
physical therapy, including research, fit- research for the more than 100 types of
ness guides, and an online directory of cer- arthritis and related conditions.
tified therapists that is searchable by state
Centers for Medicare and Medicaid
and specialty.
Services (CMS)
American Speech-Language-Hearing U.S. Department of Health and
Association (ASHA) Human Services
http://www.asha.org/default.htm http://www.cms.gov
800-638-8255 (voice and TTY); 877-267-2323
8:30 a.m. to 5 p.m., Eastern Time TTY: 866-226-1819
ASHA provides callers with referrals to CMS is the federal government agency
certified speech-language pathologists responsible for the Medicare and Medicaid
and audiologists throughout the country. health insurance programs. CMS offers
The association also helps consumers to information about Medicare and Medicaid
find therapists who are bilingual or have coverage.
special skills.
CARF, the Rehabilitation
American Therapeutic Recreation Accreditation Commission
Association (ATRA) http://www.carf.org
http://www.atra-tr.org/atra.htm 520-325-1044, voice and TTY
703-683-9420
CARF is an independent, not-for-profit
The American Therapeutic Recreation organization that reviews and accredits
Association (ATRA) is the largest, national rehabilitation facilities to help ensure high-
membership organization representing quality care and the best possible out-
the interests and needs of recreational comes. CARFs Web site includes a list of
therapists. accredited rehabilitation programs that
can be searched by state and program
type. Click on the Search for a Provider
link from the home page.

DisabilityInfo.gov Joint Commission on Accreditation of

http://www.disabilityinfo.gov Healthcare Organizations (JCAHO)
http://www.jcaho.org/qualitycheck/
DisabilityInfo.gov is a comprehensive fed-
directry/directry.asp
eral Web site of disability-related govern-
630-792-5000, 8 a.m. to 5 p.m.,
ment resources. It offers information about
Central Time
employment, housing, transportation,
technology, and other topics. JCAHO looks at how well health care pro-
grams, including rehabilitation programs,
Disability Resources
meet standards of quality in care. JCAHOs
http://www.disabilityresources.org
Web site includes the accreditation scores,
Disability Resources is a nonprofit group or status, of rehabilitation and other
that seeks to promote and improve aware- health care organizations.
ness, availability, and accessibility of infor-
Medical Rehabilitation Education
mation to help people with disabilities live
Foundation
independently. Its Web site includes infor-
800-GET-REHAB (800-438-7342),
mation about government agencies and
8 a.m. to 8 p.m. Eastern Time
non-profit organizations, publications,
TTY: 800-688-6167
databases, and online guides.
The Medical Rehabilitation Education
Independent Living Research
Foundation provides information about
Utilization (ILRU)
the benefits of medical rehabilitation and
http://www.ilru.org
refers callers to rehabilitation providers
713-520-0232
nationwide.
TTY: 713-520-5136
National Clearinghouse of
ILRU is a national center for information,
Rehabilitation Training Materials
training, research, and technical assistance
(NCRTM)
in the area of independent living. Its Web
http://www.nchrtm.okstate.edu
site offers a national directory of independ-
800-223-5219
ent living centers and information about
TTY: 405-744-2002
living independently with a disability.
NCRTM is a federally funded clearinghouse
that provides a variety of educational and
training materials to the rehabilitation
community. Its Web site offers links to
other disability and rehabilitation-related
sites.

National Institute on Disability and National Spinal Cord Injury

Rehabilitation Research (NIDRR) Association (NSCIA)
U.S. Department of Education http://www.spinalcord.org
http://www.ed.gov/about/offices/list/ Toll-free helpline: 800-962-9629
osers/nidrr/index.html?src=mr
The National Spinal Cord Injury
202-205-8134
Association is dedicated to improving the
TTY: 202-205-4475
quality of life for individuals living with
NIDRR provides leadership and support for spinal cord injury and disease and their
research related to the rehabilitation of families. They strive to educate and
people with disabilities. empower individuals with spinal cord
injury and disease to maintain independ-
National Multiple Sclerosis Society
ence, health, and personal fulfillment.
(NMSS)
http://www.nmss.org National Stroke Association
1-800 FIGHT MS (1-800-344-4867) http://199.239.30.192/NationalStroke/
Default.htm
The mission of the National Multiple
1-800-STROKES (1-800-787-6537)
Sclerosis Society is to end the devastating
effects of MS. The Society promotes The leading resource for stroke, the mis-
research, education, and advocacy for the sion of the National Stroke Association is
newley diagnosed and those living with to reduce the incidence and impact of
MS over time. stroke, improve quality of care, and
increase patient outcomes. They provide
National Rehabilitation Information
education, services and community-based
Center (NARIC)
activities in prevention, treatment, rehabil-
http://www.naric.com
itation and recovery.
800-346-2742
TTY: 301-495-5626 National Therapeutic Recreation
Society
NARIC is a federally funded library and
http://www.nrpa.org
information center concerned with disabil-
703-858-0784
ity and rehabilitation. It offers disability-
related information, resources, and access The National Therapeutic Recreation
to research findings. Society (NTRS) is an organization for those
interested in the provision of therapeutic
recreation services for people with disabil-
ities. NTRS is a branch of the National
Recreation and Park Association (NRPA).

Nursing Home Compare mation on funded studies and research

http://www.medicare.gov/nhcom- statistics.
pare/home.asp
Social Security Administration (SSA)
800-MEDICARE (800-633-4227)
http://www.ssa.gov
This Web site was created by the federal 800-772-1213, 7 a.m. to 7 p.m.,
Centers for Medicare and Medicaid onday - Friday
Services (CMS), which runs the Medicare TTY: 1-800-325-0778, 7 a.m. to 7 p.m.,
and Medicaid programs. It helps con- Monday - Friday
sumers to find nursing homes in specific
SSA offers information about Social
geographic areas.
Security Disability Insurance (SSDI) and
Office of Disability Employment other benefits that persons with disabilities
Policy (ODEP) may be eligible for. SSAs Web site includes
U.S. Department of Labor contact information and Web sites for
http://www.dol.gov/odep/ state rehabilitation services departments
866-633-7365 or vocational rehabilitation offices at
TTY: 877-889-5627 http://www.ssa.gov/disability
ODEP works to increase employment State Vocational Rehabilitation

opportunities for adults and youth with Services Departments
disabilities. Its Web site includes facts
These individual state departments will
sheets and other publications about
have helpful information on state pro-
employment of persons with disabilities,
grams for people with disabilities, as well
links to employers that wish to hire per-
as job and rehabilitation information. Each
sons with disabilities, and information
state will offer different services and
about employment-related programs.
resources. Following is a list of the contact
Rehabilitative Services information for each of the 50 states and
Administration (RSA) the District of Columbia:
U.S. Department of Education
Alabama
http://www.ed.gov/about/offices/list/
http://www.rehab.state.al.us
osers/rsa/index.html
800-441-7607
202-205-5482
Alaska
RSA oversees programs that help people
http://www.labor.state.ak.us/dvr/
with disabilities live independently by pro-
home.htm
viding counseling, job training, and other
800-478-2815
services. The RSA Web site includes infor-

Arizona Georgia
http://www.de.state.az.us/rsa/ http://www.vocrehabga.org/
default.asp 404-232-3910
602-542-3332 TTY: 404-232-3911
TTY: 602-542-6049
Hawaii
Arkansas http://www.state.hi.us/dhs/
http://www.arsinfo.net/index.html 808-692-7722
501-296-1600
Idaho
TTY: 501-296-1669
http://www2.state.id.us/idvr/
California 208-334-3390
http://www.rehab.cahwnet.gov/
Illinois
916-263-8981
http://www.dhs.state.il.us/ors/
TTY: 916-263-7477
800-843-6154
Colorado TTY: 800-447-6404
http://www.cdhs.state.co.us/ods/dvr/
Indiana
ods_dvr1.html
http://www.state.in.us/fssa/
303-866-4150
servicedisabl/
Connecticut 317-232-1252
http://www.brs.state.ct.us/index.html
Iowa
800-537-2549
http://www.dvrs.state.ia.us/
TTY: 860-424-4839
515-281-4211 (voice and TTY)
Delaware
Kansas
http://www.delawareworks.com/
http://www.srskansas.org/rehab/
divisions/dvr/welcome.htm
index.htm
302-761-8275
888-369-4777
TTY: 302-761-6611
Relay: 800-766-3777
District of Columbia
Kentucky
http://dhs.dc.gov/info/rehabservices.
http://www.glasgowbarren.com/
shtm
glas_acc/vrehab/pages/reachus.htm
202-442-8400
502-651-5147
TTY: 202-442-8600
Louisiana
Florida
http://www.dss.state.la.us/offlrs/index.
http://www.rehabworks.org/
htm
800-451-4327 (voice and TTY)
800-737-2958

Maine Nebraska
http://www.state.me.us/rehab/ http://www.vocrehab.state.ne.us/
800-698-4440 402-471-3644
TTY: 888-755-0023
Nevada
Maryland http://detr.state.nv.us/rehab/index.htm
http://www.dors.state.md.us/ 775-684-4040
888-554-0334 TTY: 775-684-8400
Massachusetts New Hampshire

http://www.state.ma.us/mrc/ http://www.ed.state.nh.us/VR/
800-245-6543 (voice and TTY) 800-299-1647
TTY: 603-271-3471
Michigan
http://www.michigan.gov/mdcd/0, New Jersey
1607,7-122-25392-,00.html http://www.state.nj.us/
866-MY-GOALS humanservices/disable/index.html
888-285-3036
Minnesota
http://www.mnwfc.org/programs/ New Mexico
vorehab.htm http://www.dvrgetsjobs.com/Public/
800-328-9095 Index.asp
TTY: 800-657-3973 877-475-8226 (voice and TTY)
Mississippi New York

http://www.mdrs.state.ms.us http://www.vesid.nysed.gov/
800-962-2230 800-222-JOBS(5627)
Missouri North Carolina

http://www.vr.dese.state.mo.us/vr/co/ http://dvr.dhhs.state.nc.us/
VRWeb site.nsf 919-855-3500
877-222-8963
North Dakota
TTY: 573-751-0881
http://lnotes.state.nd.us/dhs/dhsweb.
Montana nsf/ServicePages/DisabilityServices
http://www.dphhs.state.mt.us/dsd/ 800-755-8529
govt_programs/vrp/ TTY: 701-328-8968
877-296-1197
Ohio
TTY: 406-444-2590
http://www.state.oh.us/rsc/
614-438-1200 (voice and TTY)

Oklahoma Vermont
http://www.okrehab.org/ http://www.vocrehabvermont.org/
800-845-8476 866-VRWORKS (866-879-6757) (voice
and TTY)
Oregon
http://www.dhs.state.or.us/disabilities/ Virginia
503-945-5944 http://www.vadrs.org/
TTY: 503-947-5330 800-552-5019 (voice and TTY)
Pennsylvania Washington
800-442-6351 http://www1.dshs.wa.gov/dvr/
http://www.dli.state.pa.us/landi/cwp/ 800-637-5627 (voice and TTY)
view.asp?a=195&Q=68442&landiRNav
West Virginia
radC6865=|&landiRNavradC1381=|
http://www.wvdrs.org/
TTY: 800-233-3008
800-642-8207
Rhode Island
Wisconsin
http://www.ors.state.ri.us/
http://www.dwd.state.wi.us/dvr/
401-421-7005
800-442-3477
TTY: 401-421-7016
TTY: 888-877-5939
South Carolina
Wyoming
http://www.scvrd.net/scvrinfo.htm
http://dwsweb.state.wy.us/vr.asp
803-896-6500
307-777-7389
South Dakota
http://www.state.sd.us/dhs/drs/
United Cerebral Palsy (UCP)
605-773-3195
http://www.ucp.org/
Tennessee 800-872-5827
http://www.state.tn.us/humanserv/ TTY: 202-973-7197
VRServices.html
The United Cerebral Palsy is the leading
615-313-4714 (voice and TTY)
source of information for individuals with
Texas cerebral palsy. They advocate for the
http://www.rehab.state.tx.us/index.html rights of persons with disabilities and
800-628-5115 strive to advance the independence and
productivity of people with disabilities.
Utah
http://www.usor.utah.gov
800-473-7530


Center for Health & Disability Research
102 Irving Street, NW
Washington, DC 20010-2949
www.nrhchdr.org

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Choosing a High-Quality

Medical Rehabilitation Program:

TO DOWNLOAD A PDF VERSION OF THIS GUIDEBOOK, GO TO WWW.NRHRESEARCH.ORG/CHDR/REHABGUIDE

This guidebook was prepared by Melinda T. Neri at the National Rehabilitation

PART 1: MEDICAL REHABILITATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

PART 2: HEALTH INSURANCE PLANS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

PART 3: CHOOSING A REHABILITATION PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

PART 4: QUALITY AND REHABILITATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

QUALITY CHECKLISTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

NRH Center for Health and Disability Research iii

STEPS FOR CHOOSING A HIGH-QUALITY REHABILITATION PROGRAM

iv NRH Center for Health and Disability Research

NRH Center for Health and Disability Research 1

MARTINS STORY: THE ROAD TO RECOVERY

2 NRH Center for Health and Disability Research

KERRYS STORY: THE ENVIRONMENT AND DISABILITY

NRH Center for Health and Disability Research 5

MEDICAL REHABILITATION IS DIFFERENT FOR EVERYONE

6 NRH Center for Health and Disability Research

NRH Center for Health and Disability Research 7

Chaplain Rehabilitation case manager

Clinical neuropsychologist Rehabilitation engineer

Clinical psychologist Rehabilitation nurse

Dietician Respiratory therapist

Occupational therapist Social worker

Orthotist Speech-language therapist

Physiatrist Therapeutic recreation specialist

Physical therapist Vocational rehabilitation specialist

POINTS TO REMEMBER FROM THIS SECTION

8 NRH Center for Health and Disability Research

HEALTH INSURANCE PLANS

NRH Center for Health and Disability Research 11

12 NRH Center for Health and Disability Research

Whats the difference between What does Medicare cover?

NRH Center for Health and Disability Research 13

POINTS TO REMEMBER FROM THIS SECTION:

14 NRH Center for Health and Disability Research

CHOOSING A REHABILITATION PROGRAM

HOW DO REHABILITATION Nursing home rehabilitation.

services are provided, and In an acute rehabilitation program, a team

Who provides the services. designs a personalized, interdisciplinary

NRH Center for Health and Disability Research 17

T YPES OF REHABILITATION PROGRAMS

Acute At an acute Medical care, physical 24-hour At least 3 hours

18 NRH Center for Health and Disability Research

NRH Center for Health and Disability Research 19

20 NRH Center for Health and Disability Research

LOLAS STORY: FINDING A QUALITY REHABILITATION PROGRAM FOR YOUR NEEDS

NRH Center for Health and Disability Research 21

POINTS TO REMEMBER FROM THIS SECTION:

22 NRH Center for Health and Disability Research

QUALITY AND REHABILITATION

PART 4: Reports to compare the cost, reliability, and

Rehabilitation In the same way, when you are looking for

this information, you will be able to com- of Americas best

pare the rehabilitation programs and hospitals,

services that you are choosing from. including

In health care, quality refers to You can also contact

providers is like comparing products you rehabilitation services is to look at rehabil-

NRH Center for Health and Disability Research 25

In the rehabilitation setting, outcomes Information about rehabilitation outcomes

MORE ABOUT When measured at patients and families, based

26 NRH Center for Health and Disability Research