The Hidden Rehab Option No One Tells You About
Imagine this: your loved one has a fall, breaks a hip, and undergoes surgery. The surgery goes smoothly, but now comes the big question—what happens next? Where should recovery take place?
As an occupational therapist with years of experience working in multiple rehab settings, I’ve seen how overwhelming these choices can be. Families often aren’t told about all the options, and that can lead to longer, more difficult recoveries than necessary. Let’s break down the main rehabilitation pathways after a fall so you can make an informed decision.
And while I’m using a hip fracture as the example, these same rehab options apply to recovery after many major health events—such as a stroke, heart surgery, or a flare-up of a chronic condition.
The Usual Pathways After Hospitalization
Acute Inpatient Rehab (AIR)
This is often considered the “gold standard” of post-hospital rehab.
Who qualifies: Patients who are medically complex and can tolerate three hours of therapy per day.
Benefits: Intensive therapy, 24/7 nursing care, and typically quicker recovery. Most people go home within a few weeks.
Limitations: Strict admission criteria—if you’re not strong enough or don’t have enough medical complexity, you may not qualify.
“If you or your loved one is highly motivated and can handle the intensity, acute rehab can be the fastest way back to independence.”
Skilled Nursing Facility (SNF)
This is where patients often go if they can’t tolerate intensive therapy or need more intensive medical support.
Who qualifies: Patients who are weaker, less stable, or have more complex needs.
Benefits: Nursing staff available around the clock, daily therapy at a lower intensity.
Limitations: Less therapy often means slower progress, and stays here can stretch on much longer than inpatient rehab.
“Be aware: progress in SNFs is usually slower, and the risk of “losing ground” while waiting for discharge is higher.”
The Often Overlooked Option: Home Health + In-Home Caregiver Support
This option doesn’t get talked about enough—but in my experience, it can be a game-changer. Instead of transferring to a facility, patients can go home with home health services and add in-home caregiver support to fill in the gaps.
Benefits:
Recovery in the comfort of home.
Caregivers can help with medications, bathing, meals, and light housekeeping.
Access to home health nursing, occupational therapy, and physical therapy services several times a week.
Greater independence and family involvement.
Often results in a faster, more positive recovery compared to long SNF stays.
Limitations:
If you require complex medical care (like IV medications or advanced wound care), skilled facilities may still be necessary.
“An investment in caregiving support often leads to better recovery and a higher quality of life”
What’s the difference between Home Health & In-Home Care?
Home Health: A medical service, covered by insurance if you qualify. Includes visits from a nurse (to check wounds, vitals, and medications) and therapy services such as occupational therapy and physical therapy.
In-Home Care: A non-medical service. Caregivers help with daily activities such as bathing, dressing, meal prep, light housekeeping, medication reminders, and even standby support for safety.
Both are valuable, but they serve very different purposes. Case managers are familiar with sending people home with home health. However, they rarely coordinate with in-home caregiver agencies—which means families often miss out on this powerful combination.
Advocating For This Option
Here’s the piece many families don’t realize: you may have to advocate for this path. Case managers want to be sure you’ll be safe at home, so they may default to recommending a rehab facility. If you prefer to recover at home, you’ll need to show that in-home caregiving is already in place or in process.
Here’s how to do that:
Ask the case manager to help connect you with a home health agency.
Search for local in-home care companies, or—if you’d rather not go it alone—connect with a professional (like me) who already has strong relationships with trusted providers.
Involve your therapy team: the occupational and physical therapists who evaluate you after surgery are part of the discharge planning process. Ask them directly whether a home health + in-home caregiver setup is safe for you, especially if you don’t qualify for inpatient rehab.
“If you want to go home, speak up early. Tell your case manager and therapy team your preference, and ask what steps you need to take to make it possible.”
Creative solutions like this—and helping clients advocate for them—are exactly what I specialize in at qualOT of life. I help families explore every available option, connect with trusted local services, and create recovery plans that truly support safety, independence, and quality of life.
Beyond Rehab: Outpatient Therapy and Prevention
Recovery doesn’t stop once you’re discharged from home health or rehab. Outpatient therapy can help you keep building strength and reduce the risk of another fall.
Here’s something many people don’t realize: you don’t have to wait for your doctor to suggest therapy—you can ask for an order yourself.
Outpatient therapy is especially valuable for:
Fall prevention.
Regaining balance and strength.
Improving independence in daily activities.
“Here’s a helpful hint: Think of outpatient therapy as your yearly “tune-up.” Just like you see your doctor for a check-up, scheduling a therapy session once a year can help you stay strong and confident.”
In conclusion…
A fall and surgery can be overwhelming, but recovery doesn’t have to mean a long stay in a skilled nursing facility. With the right plan—whether that’s acute rehab, home health, or a creative caregiver + therapy combination—you can take control of the healing process.
And don’t forget: you have the power to advocate for yourself. Ask about outpatient therapy, consider yearly tune-ups, and explore all the options to find the path that leads to the best recovery and quality of life.
Here’s to healthier, safer, and stronger days ahead,
Dr. Lyndi, Occupational Therapist & Founder of qualOT of life
