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Skilled nursing facilities after joint replacement

Introduction

Most people hope to go home directly from the hospital after surgery to replace a joint. Even if you and your doctor planned for you to go home after surgery, your recovery may be slower than expected. As a result, you may need to be transferred to a skilled nursing facility.

You should talk about this issue with your doctors and nurses in the weeks before your joint replacement. They can advise you about whether going directly home is right for you.

Before surgery, it is important to decide on the facility you would like to go to after you leave the hospital. You want to choose a facility that provides quality care and is located in a place that works best for you.

Make sure the hospital knows about the places you have chosen and the order of your choices. Find second and third choice options. If there is no bed available in your first choice facility, the hospital still needs to transfer you to another qualified facility.

Who needs to go to a skilled nursing or rehabilitation facility?

Before you can go home after surgery, you must be able to:

  • Safely use your cane, walker, or crutches
  • Get in and out of a chair and bed without needing much help
  • Walk around enough that you will be able to move safely between where you are sleeping, your bathroom, and your kitchen
  • Go up and down stairs, if there is no other way to avoid them

Other factors may also prevent you from going directly home from the hospital.

  • Your surgery may be more complicated.
  • You do not have enough help at home.
  • Because of where you live, you need to be stronger or more mobile before going home.
  • Sometimes infections, problems with your surgical wound, or other medical issues will prevent you from going right home.
  • Other medical problems, such as diabetes, lung problems, and heart problems, have slowed down your recovery.

Choosing the right facility for you

A doctor will supervise your care. Other trained health care providers will help you grow stronger:

  • Registered nurses will care for your wound, give you the right medicines, and help you with other medical problems.
  • Physical therapists will teach you how to make your muscles stronger. They will help you learn to get up and sit down safely from a chair, toilet, or bed. They will also teach you how to climb steps, keep your balance, and use your walker, cane, or crutches.
  • Occupational therapists will teach you the skills you need to do everyday tasks such as putting on your socks or getting dressed.

Visit two or three facilities. Choose more than one facility at which you would be comfortable. When visiting, ask the staff questions such as:

  • Do they take care of many people who have had a joint replacement? Can they tell you how many? A good facility should be able to show you data that shows they provide quality care.
  • Do they have physical therapists who work there? Make sure the therapists have experience helping people after joint replacement.
  • Will you see the same one or two therapists most days?
  • Do they have a plan (also called a pathway, or protocol) for taking care of patients after joint replacement?
  • Do they provide therapy every day of the week, including Saturday and Sunday? How long do therapy sessions last?
  • If your primary care doctor or your orthopedic surgeon does not visit the facility, will there be a doctor in charge of your care?
  • A good facility will take the time to teach you and your family or caregivers about the care you will need in your home after you leave the facility. Ask how and when they provide this training.

References

Centers for Medicare and Medicaid Services. Medicare coverage of skilled nursing facility care. Available at http://www.medicare.gov/Pubs/pdf/10153.pdf. Accessed August 20, 2013.

Dejong G, Horn SD, Smout RJ, et al. Joint replacement rehabilitation outcomes on discharge from skilled nursing facilities and inpatient rehabilitation facilities. Arch Phys Med Rehabil. 2009;90:1284-96.


Review Date: 8/12/2013
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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