Convalescent Homes

When a pipe breaks, you call a plumber.  When you break your tooth, you call your dentist.  But what if you or someone you know has a medical emergency or surgery and can’t go directly go home after a stay in the hospital?  What if someone no longer needs to be in the hospital, but needs help recovering and can’t go home?  No one thinks of convalescent homes until they need one, but then they need to find one right away.

Unfortunately, you might be faced with this dilemma at a time when you are already overloaded with stress and medical jargon.  No one plans on having a stroke or a medical emergency.  Trying to process this information when you are thrown into a medical emergency whirlwind is confusing and can be overwhelming.

How do you make sense of all this?  Convalescent homes?  Nursing Homes?  Skilled Nursing? Aren’t they all the same?  The short answer is yes, but also no.  They can generally provide the same sort of medical services.  The length of stay and the expected outcome are a good way to differentiate the types of facilities.

What is a Convalescent Home?

A convalescent home is commonly referred to as a Skilled Nursing Facility (SNF), Rehabilitation Hospital, Inpatient Rehabilitation Facility or Continuum Care Facility.  Convalescent homes can either be a freestanding hospital (sometimes referred to as a convalescent hospital) or hospital-based unit, or extension of hospital care.  People go to a convalescent home specifically when they need rehabilitative medical care only available from medical professionals, such as doctors, nurses, or therapists, but they no longer require hospitalization.

For Medicare purposes, skilled nursing facility, nursing home, and convalescent home are all terms for a residential care facility providing 24-hour medical care.  “Skilled Nursing” refers to a high-level of care provided by trained professionals.

A convalescent home is specifically for recovery purposes and is generally short term in nature.  The goal of a convalescent home is to discharge the patient after regaining function.  Another goal might be for the patient to learn to adapt so they are able to return to as normal a life as possible if full recovery is not achievable.

On average, about 70% of convalescent home patients are discharged to return home.  Half of those discharged patients continue some sort of home health care service.  Inpatient care at a convalescent home would include beds, meals, diagnostic and therapeutic services medically necessary for recovery.

Sadly, not every illness or injury can be cured or reversed.  Convalescent homes are not appropriate for patients of irreversible or chronic conditions or those who need constant 24/7 skilled nursing care.

A convalescent home is different from a nursing home.  A nursing home is for patients needing daily medical care to live and is generally a continuing need.  A nursing home is usually a permanent solution to a decrease in wellbeing.  This is why nursing homes are also referred to as Long Term Care facilities.  There is generally no expectation that a nursing home patient’s medical condition will sufficiently improve to enable them to return home or live independently.

A nursing home might accept patients seeking short-term recovery.  Because the majority of nursing home patients are not expected to improve, there might not be therapists on staff to effectively help a patient “recover”.  You should discuss the pros and cons with your doctor if you are considering using a nursing home for short-term recovery rather than a convalescent home.

A convalescent home is different from an assisted living facility.  Assisted living facilities provide supervision and support 24-hours, but not necessarily 24-hour “skilled care”.  Assisted living facilities provide every day personal care assistance and aren’t generally considered medical facilities. However, assisted living facilities may also be a good choice for short-term stays, depending on the type of the facility and your specific care needs.

When is a Convalescent Home Needed?

A doctor is generally the best judge of whether a stay at a convalescent home is appropriate.  A doctor can consult with the medical staff of a convalescent home to assess the individual case and prognosis.  The doctor can then provide judgement on whether that home is able to meet the patient’s needs.

A convalescent home is typically used for short term recovery.  This might be from just a few days to 6 months.  The medical professional team of a convalescent home will continue to strive for recovery as long as there is progress toward recovery.

Many patients in convalescent homes are recovering from strokes, accidents, or post-operation.  Time and practice is needed to fully heal or adapt to physical changes, but a hospital room and hospital resources are not required for that healing process.

Type of Care in a Convalescent Home

20% of convalescent home patients are admitted after experiencing a stroke, 40% after a fracture of the lower extremity which has reduced mobility, and 11% after major joint replacement.  The remaining 29% are for a variety of conditions.

The primary goal of convalescent homes is patient rehabilitation and recovery.  Restoring function is the cornerstone of the patient care plan in convalescent homes, unlike in nursing homes.  This is the fundamental difference between convalescent homes and nursing homes.

The average patient stay at a convalescent home is 13 days, but it is dependent on the patient and the situation.

A convalescent home has a team of medical professionals, each with a specialty to contribute to the patient’s recovery.  A treatment plan is developed and monitored by the team to meet the needs of each patient.  This treatment plan works to mesh the different disciplines, rather than a purely linear path towards recovery.

A team at a convalescent home usually includes physicians, psychologists, rehabilitation nurses, physical therapists, occupational therapists, speech therapists, recreational therapists, case managers, dieticians and clergy.  Each plays a special role in the mental, physical and spiritual recovery of the patient.

Rehabilitation and recovery in convalescent homes is intensive and hard work for the patient.  There are several sessions per day totaling more than 3 hours in total, Monday through Friday.  There is typically a religious service available on Sunday if desired and no formal rehabilitation sessions.

Occupational Therapists in convalescent homes intertwine physical and mental abilities with personal daily needs, such as bathing and dressing.  The goal is to for the patient to regain as much independence as possible.

Speech Therapists in convalescent homes are focused on redeveloping communication, thinking, and reasoning skills.  Speech therapists also work with patients who have trouble swallowing.

Psychologists in convalescent homes help patients with motivation, their attitude, and their coping skills.  Rehabilitation can be frustrating and demoralizing with the hard work and setbacks along the way.  Staying motivated and positive through the process can be the hidden key to success.

Physical Therapists in convalescent homes help patients regain physical strength, endurance and coordination.  Some might think physical therapists are only necessary for sports injuries, but muscle loss and physical conditioning can deteriorate quickly if mobility is hindered.

Convalescent homes provide medical services that can’t be provided in a patient’s home.  The skilled care provided might include wound care, IV Therapy, injections, physical therapy, monitoring of vital signs, and use of specialized medical equipment requiring special training.

How to Pay for a Convalescent Home

Convalescent homes are considered short-term in nature, so they are billed on a daily basis, similar to a hospital.  There are a variety of sources of payment, depending on the case.  These include Medicare, Medicaid, private insurance, employer insurance, VA, and workman’s compensation.

Medicare is usually the initial source of payment.  Medicare was intended for short-term care so it meshes well with the need and use of convalescent homes.  Approximately 70% of rehabilitation patients use Medicare benefits for payment of services.  Coverage might be included in supplemental plans and PACE programs (Programs of All-Inclusive Care for the Elderly).

Currently, Medicare has a general limit of 100 days at a convalescent home however it does not pay 100% coverage for all 100 days.  Medicare pays for medical services, but does not pay for custodial care, such as bathing, feeding, etc.  Medicare has a decreasing benefit scale, so the longer a stay in a convalescent home, the less Medicare will pay.  Medicare coverage is extended to 190 days for treatment of a psychiatric condition.

A medical facility accepting Medicare is subject to federal guidelines.  Medicare will not pay claims submitted by non-Medicare-approved facilities so it is very important to confirm this compliance before starting patient care with a facility if you plan on paying with Medicare.

Perhaps one silver lining in this situation is that a skilled nursing facility is considered a medical facility.  A medical facility’s charges should then be able to be considered medical expenses and therefore might be tax deductible.  You should consult a tax professional to confirm this applies to you situation.

Medicare.gov recommends that patients assess if a convalescent home or nursing home accepts Medicaid, regardless of whether a patient has private resources or has been previously ineligible for Medicaid due to income limits.  Medical costs can be expensive so a patient might not initially qualify for state run Medicaid programs, but might spend down their private resources to later qualify.  Some states have higher income limits specifically for skilled nursing facility patients due to the high cost of these services.

Long-term care insurance varies based on the plan that was purchased.  Some plans cover only nursing homes and some are more flexible so convalescent homes might be covered under this type of plan.

There are benefits of being a veteran.  The VA does not differentiate facilities based on duration of stay.  The VA recognizes the term of skilled nursing care as a level of care provided.  The VA provides for Community Living Centers (VA Nursing Homes), Community Nursing Homes (Non-VA Nursing Homes), and State VA Homes.  The VA has eligibility requirements that must be met.  These include service status, level of disability, and income.  State VA Homes are owned, operated and managed by each individual state, but must be recognized officially and certified by the VA.  Some states allow spouses of veterans to receive services and some do not.

It might seem radical, but some patients choose to relocate to a less costly area of the country to rehabilitate.  Convalescent homes and nursing homes can be regionally priced so it might be worth exploring the possibilities if it suits the situation.

How do I Find a Convalescent Home Near Me?

Most patients of convalescent homes arrive directly after a hospital stay.  The average is 3 days in the hospital before transferring to begin a treatment plan for recovery.

A patient will not be accepted into a convalescent home without a doctor referral so it must be deemed medically necessary.  A doctor will know what services are needed for the patient’s recovery and will generally know the services provided in the area and is therefore a very good resource to assure that the proper services will be available for recovery.

A hospital case worker or discharge personnel are also very good resources to consult since transferring patients to convalescent homes is a common event, although they may recommend a skilled nursing facility near you instead of dedicated convalescent homes.  These hospital workers should be able to offer some good input on a convalescent home’s operating procedures and some insight into what the home is like to work with.

Quick Recap of Convalescent Homes:

Suddenly needing the services of a convalescent home can be unnerving and stressful.  Medical terms and jargon are thrown about by people who are used to these and probably don’t realize what you don’t understand.  Ask them to stop and explain so that you understand.  Ask questions so that you understand how to get the care that is required.

Convalescent homes are medically prescribed.  A patient’s condition must meet the criteria for the facility.  A doctor will determine the patient’s prognosis and suitability of the services provided in a convalescent home.

Convalescent homes are skilled nursing facilities.  With all the different confusing terms that are used, this one term is important in assessing services provided, as well as insurance coverage.

Convalescent homes are intended for short-term recovery.  Convalescent homes are not suitable for terminal illness or chronic conditions.

Convalescent homes provide interdisciplinary patient care plans with the goal of patient recovery to return to as normal a life as possible.  Rehabilitation can require multiple people: occupational therapy, speech therapy, psychological, as well as physical therapy.  These facets mesh together to provide the patient the best chance at recovery.