Healthcare settings are so numerous and diverse that the same term can refer to different facilities.
Such is the case with inpatient rehab. Discover the different meanings of this term and understand the care patients receive in each setting.
What Is Inpatient Rehab?
Inpatient rehabilitation takes place in hospitals and other medical treatment facilities. It offers more intensive and comprehensive care than other rehab centers. Patients in these settings receive 24-hour monitoring, care, and treatment.
Patients could need rehabilitation for various reasons. They may need intensive physical, occupational, or speech therapy. They also may need inpatient treatment programs for addictions.
What Is the Definition of Inpatient?
The medical meaning of inpatient has two connotations.
The first aspect that must be mentioned to define inpatient is that it refers to facilities offering 24-hour care or patients receiving care around the clock. In other words, in patients stay in the rehab facility full-time for a given period.
Inpatient also implies acute care. Acute care typically refers to a level of medical care in which a patient receives short-term treatment for one of the following:
- A severe episode of an illness
- Treatment for conditions resulting from disease or trauma
- Post-surgical care
Both meanings of inpatient are related since acute care patients also require constant monitoring, care, and treatment.
What Is the Definition of Rehab?
Rehabilitation or rehab refers to interventions that optimize the functioning of individuals with health conditions in relation to their environments. Rehab helps individuals recover, maintain, or improve the abilities they need for their daily lives.
People may need rehabilitation after an illness, an injury, or surgery. Others may need rehab to treat addiction to alcohol or other drugs.
So, what is inpatient rehabilitation?
Let’s bring all these definitions together.
Inpatient rehabilitation is a setting that offers patients 24-hour healthcare services. It provides intensive interventions aimed at helping people return to their lives with the highest possible degree of autonomy and safety.
What's the Average Length of Stay for Inpatient Rehab?
The length of stay in inpatient rehab varies drastically based on the patient’s condition.
For example, one condition that often requires inpatient rehab is stroke.
- A stroke patient with mild impairments typically stays in an inpatient rehab facility for 8.9 days.
- A patient with mild impairments stays for an average of 13.9 days.
- A stroke patient with severe impairments typically requires 22.2 days of intensive rehab.
These inpatient rehab patients may require physical therapy, occupational therapy, speech-language therapy, or a combination.
Drug and alcohol rehab can also vary drastically in length.
According to American Addiction Centers, rehab programs can last anywhere from a few days to many years.
Inpatient medical detoxification typically lasts seven days or more. Medical detox helps patients with withdrawal symptoms.
After detoxification, a patient’s healthcare team may recommend outpatient or inpatient drug rehab programs.
- Some treatment programs may last two weeks to 30 days.
- Others may last 60 to 90 days or more.
- Six-month, one-year, and two-year programs are also available.
- There are also long-term recovery programs, such as sober living homes.
What Are Long-Term Inpatients?
Long-term inpatients are patients who require acute care for an extended period. According to the Centers for Medicare and Medicaid Services (CMS), this term applies to patients requiring more than 25 days of acute care.
Acute Rehab vs. Inpatient Rehab vs. Skilled Nursing
Acute rehab, inpatient rehab, and skilled nursing are all types of facilities that offer rehabilitation services. In some cases, these terms overlap. Here’s the breakdown.
Acute Rehab vs. Inpatient Rehab
As mentioned previously, inpatient settings typically imply acute care. Understanding inpatient in this way would make these terms synonymous.
However, sometimes, the word inpatient simply refers to 24-hour care. In this case, an inpatient rehab facility could offer around-the-clock care to residents without being an acute care facility.
Inpatient Rehab vs. Skilled Nursing
As mentioned, in some cases, “inpatient rehab” simply refers to a facility that offers 24-hour care and rehabilitation. That is the exact definition of a skilled nursing facility (SNF). Therefore, without the acute care connotation, an inpatient rehab facility would be the same as a skilled nursing facility.
What Is Another Meaning of Inpatient Rehab?
Sometimes, rehab refers to facilities that treat substance use disorders (SUDs). In this context, inpatient rehab could still be synonymous with acute rehab for patients with SUDs.
However, it may refer to a residential treatment program for patients with substance use disorders. Residential facilities offer 24-hour care but are not acute care settings.
Occasionally, patients with SUDs enter skilled nursing facilities for rehabilitation and post-acute care. (Post-acute refers to the care patients receive after hospital stays.) However, skilled nursing facilities are not adequately prepared to care for patients with substance use disorders.
Regulations around treatment for substance abuse may limit the treatment patients can receive in skilled nursing.
For example, federal regulations allow a patient with opioid use disorder (OUD) who is part of an opioid treatment program (OTP) to continue receiving methadone treatment during a hospital or SNF stay.
However, state regulations may not allow this treatment in an SNF. Additionally, some SNFs may not have the methadone, and the patient’s OTP may not provide it to the SNF.
Due to these limitations, skilled nursing facilities are not ideal settings for patients with substance use disorders.
Where Do People Receive Treatment for Addictions?
Individuals with substance use disorders may receive treatment in various types of medical centers.
Some facilities offer outpatient services, meaning patients do not stay at these facilities 24 hours. Others are inpatient facilities, meaning patients receive care and treatment around the clock.
The American Society of Addiction Medicine (ASAM) Criteria is currently the most widely used set of standards for addiction treatment. Many states have incorporated at least part of these criteria into their guidelines for patient placement and Medicaid health insurance reimbursement.
The ASAM Criteria recommends the following four levels of care.
Level I: Outpatient Treatment
As the name indicates, this type of treatment is nonresidential. Outpatient facilities provide evaluation, treatment, and recovery services for addicted patients. Patients typically receive fewer than nine hours of regularly scheduled treatment sessions per week.
Level II: Intensive Outpatient and Partial Hospitalization
This level of treatment is more intensive than the previous. However, it still allows patients to partially continue with their regular lives, including family, work, and school. Patients receive at least nine hours of regularly scheduled treatment sessions per week in this treatment plan.
Level III: Medically Monitored Residential Treatment
At this level, patients reside in facilities specialized in the treatment of addiction to alcohol or other drugs (AOD). They receive 24-hour evaluation, care, and treatment for addiction.
Level IV: Medically Managed Inpatient Treatment
Level four refers to an acute care inpatient setting. Patients in this level of care also receive 24-hour evaluation, care, and treatment for addiction. Additionally, they have the full resources of a general hospital.
Although patients receive treatment specific to AOD-use disorders, they may simultaneously receive treatment for coexisting acute biomedical and mental health conditions.
Inpatient vs. Outpatient Rehab: Addiction Treatment Criteria
The ASAM Criteria recommends these four levels of care based on multidimensional patient assessments. These assessments consider patients’ biomedical, psychological, and social needs.
Evaluations consider six criteria dimensions that indicate the severity of patients’ conditions.
Each dimension has a subset of criteria. The specific number of criteria a patient meets determines the level of care they receive.
Here are the six domains healthcare professionals evaluate.
Dimension 1: Acute Intoxication and Withdrawal Potential
Healthcare professionals cannot monitor acute intoxication adequately in outpatient settings. Therefore, patients with acute intoxication must receive 24-hour monitoring and care in inpatient settings.
Furthermore, healthcare professionals must assess whether a patient is at risk of experiencing life-threatening withdrawal symptoms. They also must evaluate a patient’s need for medication or other support services to cope with or reduce the discomfort of withdrawal.
Life-threatening withdrawal symptoms and other acute care needs (level four) require inpatient rehab.
Dimension 2: Biomedical Conditions or Complications
Other conditions may complicate the treatment of people with SUDs. Individuals with cardiovascular, liver, or gastrointestinal diseases may require acute care medical monitoring or treatment.
In these cases, inpatient treatment in the hospital setting (level four) is more appropriate than the three other options.
Dimension 3: Emotional and Behavioral Conditions
Emotional and behavioral health conditions may complicate the treatment and recovery of people with substance use disorders. These conditions may result from the SUD itself, such as intense feelings of guilt. They may also be independent, coexisting psychiatric disorders.
Depending on the severity of these conditions, patients may need higher levels of care. For example, if there is a risk of suicide, a patient requires 24-hour supervision.
Dimension 4: Treatment Acceptance/Resistance
Patients who recognize they have a problem and are willing to follow clinical instructions are good candidates for outpatient treatment.
On the other hand, people who deny their problems with AOD or are uncooperative typically require higher levels of care.
Dimension 5: Relapse Potential
Generally speaking, the higher the relapse potential, the greater the need for inpatient treatment.
A person’s psychological and biological background and social environment help determine their relapse potential. For example, healthcare professionals evaluate the frequency and intensity of a patient’s AOD cravings.
Dimension 6: Recovery Environment
A patient’s environment is a significant factor in their potential recovery. Patients with family and friends who support their recovery may be candidates for outpatient treatment settings.
However, inpatient settings may be more appropriate if a patient’s environment is conducive to AOD use.
How Do the Criteria Come Together?
Healthcare providers analyze the criteria from all six domains to determine patient placement.
An outpatient placement requires patients to meet level one criteria in all six dimensions. An inpatient placement in levels three or four requires a patient to meet these criteria in at least two of the six domains.
All criteria are important. However, not all determine patient placement to the same extent.
Treatment resistance, relapse potential, and recovery environment are significant factors in determining outpatient vs. inpatient treatment. The other dimensions factor heavily into deciding what level of inpatient treatment is appropriate.
Do You Want to Work in Inpatient Rehab?
Healthcare professionals have the advantage of being able to choose from a wide range of work settings.
They can work with specific age groups, levels of acuity, or particular health conditions.
Inpatient rehab itself offers numerous and diverse work opportunities. Healthcare professionals can care for patients after surgeries, illnesses, or other conditions requiring rehabilitation. They may also care for patients requiring rehabilitation for substance use disorders.
Would you like to work in inpatient rehab? Which type of inpatient rehab is right for you?
Firsthand experience is the best way to determine which setting you enjoy the most. Browse PRN job opportunities in inpatient rehab and other settings with Nursa.
Sources:
- American Society of Addiction Medicine: What is The ASAM Criteria?
- National Library of Medicine: Patient Placement Criteria
- National Library of Medicine: Length of Stay at Inpatient Rehabilitation Facility and Stroke Patient Outcomes
- National Library of Medicine: Patients with Substance Use Disorders Receiving Continued Care in Skilled Nursing Facilities following Hospitalization
- American Addiction Centers: How Long Is Rehab? Drug and Alcohol Rehab Lengths
- Centers for Medicare and Medicaid Services: What are Long-Term Care Hospitals?
