MEDICALLY CLEARED NOW WHAT? From hospital to rehab where do the children go?

Three Possibilities Home with services such as nursing and therapy in the home or outpatient in their area. Home with services such as nursing and therapy in the home or outpatient in their area. Acute Rehabilitation Facility Acute Rehabilitation Facility Sub Acute Rehabilitation Facility Sub Acute Rehabilitation Facility (Pediatric Extended Care Facility)

Who Makes the decision? It depends on the following; Occupational and physical therapists do an assessment for a level of care needs. Occupational and physical therapists do an assessment for a level of care needs. This assessment allows the medical team, case manager and social worker to advise the family on their options. This assessment allows the medical team, case manager and social worker to advise the family on their options.

Insurance Private insurance coverage depends on the plan the family has. Most plans cover cost of inpatient rehabilitation. They may limit the number of days. Private insurance coverage depends on the plan the family has. Most plans cover cost of inpatient rehabilitation. They may limit the number of days. Mass Health – Usually covers all of rehab stay. Mass Health – Usually covers all of rehab stay. No insurance – the patient waits at the hospital until insurance is approved or until they clear therapy to go home. No insurance – the patient waits at the hospital until insurance is approved or until they clear therapy to go home.

The cost of rehab in Boston to families. Families need to be financial able to stay bedside in Boston. Families need to be financial able to stay bedside in Boston. They need to be able to travel in and out of Boston. So they need a car or they need to take public transportation. They need to be able to travel in and out of Boston. So they need a car or they need to take public transportation. They need to be able to pay for gas, tolls, meals and parking. They need to be able to pay for gas, tolls, meals and parking. Can they make arrangements for other children. Can they make arrangements for other children. They may need to take a medical leave from work. They may need to take a medical leave from work. Or if they don’t have paid sick time they need to work so they can’t stay bedside Or if they don’t have paid sick time they need to work so they can’t stay bedside Families need support of other family members or friends. Families need support of other family members or friends.

Open Beds If the patient is accepted at the facility and the family agrees, they wait for an open bed If the patient is accepted at the facility and the family agrees, they wait for an open bed The patient could wait a week or longer. It is never the following day. The patient could wait a week or longer. It is never the following day. Rehabs do not take patients on a Saturday, Sunday or Holiday. Rehabs do not take patients on a Saturday, Sunday or Holiday. In that time the patient is not receiving the level of rehabilitation they need. This is usually three hours of therapy daily. In that time the patient is not receiving the level of rehabilitation they need. This is usually three hours of therapy daily. It is costly for insurance coverage because the patient is at stuck in an acute hospital setting at that daily rate. It is costly for insurance coverage because the patient is at stuck in an acute hospital setting at that daily rate. It can also be costly for the hospital if the insurance pays the hospital a lesser rate. It can also be costly for the hospital if the insurance pays the hospital a lesser rate. Since UMass Memorial Medical Center is the only pediatric unit now in Central Mass we usually need the bed for another patient. Since UMass Memorial Medical Center is the only pediatric unit now in Central Mass we usually need the bed for another patient. We compete with all of the other hospitals in Boston and all of Massachusetts for these same bed We compete with all of the other hospitals in Boston and all of Massachusetts for these same bed

Home with Services If… If Visiting Nurse is available in your area? If Visiting Nurse is available in your area? Can someone stay with the child 24/7? If a family refuses in-patient therapy. Can someone stay with the child 24/7? If a family refuses in-patient therapy. Can someone provide rides back and forth for therapy? Can someone provide rides back and forth for therapy? Can the child get into the house? Up the stairs? Into the bathroom? Can the child get into the house? Up the stairs? Into the bathroom? Will school provide tutoring? Will school provide tutoring? Can the child return to school? Can the child return to school?

Acute Rehab Facilities Franciscan’s Children’s in Boston 100 beds Franciscan’s Children’s in Boston 100 beds Spaulding Rehab Boston 16 Beds Spaulding Rehab Boston 16 Beds Fairlawn if patient is over 17 years old and they fit admission criteria Fairlawn if patient is over 17 years old and they fit admission criteria Refer to out of state rehabs for those patients from that state. Refer to out of state rehabs for those patients from that state.

Pediatric Extended Care Facilities Four in this State Four in this State They have a Post Hospitalization Program They have a Post Hospitalization Program Need approval from DPH Medical Review Team Need approval from DPH Medical Review Team Need to meet criteria individually for each facility Need to meet criteria individually for each facility Most of their clients are DDS Long Term clients Most of their clients are DDS Long Term clients Cannot provide acute rehab Cannot provide acute rehab Do not patients dependent on TPN. Do not patients dependent on TPN.

Not only Brain Injury All hospitals refer other patients to acute rehabs. They include children that have; complicated post surgical needs, stroke, Guillain-Barre, Toxic Shock, Near Drowning, Burns, and Medically complicated children including those with tracs and vents All hospitals refer other patients to acute rehabs. They include children that have; complicated post surgical needs, stroke, Guillain-Barre, Toxic Shock, Near Drowning, Burns, and Medically complicated children including those with tracs and vents

If we had an Acute Rehab Here… Boston hospitals that call us now to ask about acute rehabs in our area would also be able to discharge their patients closer to home. Boston hospitals that call us now to ask about acute rehabs in our area would also be able to discharge their patients closer to home. While a child is in Rehab they would not need to travel so far for follow-up appointments here. While a child is in Rehab they would not need to travel so far for follow-up appointments here. Children and families do not want to leave. They would like to continue their care here. They know and trust the physicians, nurses, therapists and social workers that cared for their child. Children and families do not want to leave. They would like to continue their care here. They know and trust the physicians, nurses, therapists and social workers that cared for their child. Families would be able to; spend time with other children, could continue to work, and feel more comfortable about leaving at times. Families would be able to; spend time with other children, could continue to work, and feel more comfortable about leaving at times. It would be is less costly for families. It would be is less costly for families. Other family members and friends could visit. Other family members and friends could visit. It would allow a better continuum of care for no additional financial cost. It would allow a better continuum of care for no additional financial cost.