Questions to Ask a Stroke Rehab Center
For the husband, wife or grown child of a stroke survivor who has a few days before hospital discharge to choose an inpatient rehabilitation facility, or to decide between a rehab unit and a skilled nursing facility. The questions run in the order a tour or admissions call tends to go: the center's stroke experience and whether it can take him, the therapy day, doctors and nurses, goals and family, insurance and length of stay, and the plan for going home. The patient is 'he' all the way through only to keep the wording short, so swap in your own person, and put the same questions to every center so the answers line up.
The questions
Each question, and why to ask it
Experience and fit
How many stroke patients do you admit in a year, and how many are here today?
Why ask it
A figure tells you whether stroke is the daily work of the place or an occasional admission. Put the same two numbers to every center you call, and treat 'we see lots of strokes' as a prompt to ask again.
Is there a dedicated stroke unit or program, or are stroke patients mixed in with hip, spine and other rehab patients?
Why ask it
Neither setup settles it, but a dedicated program should come with something you can point to: its own team, its own meetings, staff who work with stroke every day. If the answer is 'mixed', the follow-up is how many of the therapists and nurses on his hall mainly treat stroke.
Which accreditation or certification does the stroke program hold, and when was it last reviewed?
Why ask it
The bodies that accredit rehab differ by country. In the United States the two names that come up most are CARF and the Joint Commission. A building can be accredited as a whole without its stroke program ever being reviewed separately, so write down the exact wording and check the listing on that body's own website tonight.
What results do you track for your stroke patients, and may I see last year's?
Why ask it
Typical ones are the share who go home, how much independence people gain during the stay and how many are sent back to the hospital. A center that takes harder cases can look worse on paper, so pair the figures with who they admit.
How often do you treat people with his particular problems, such as aphasia, neglect of one side or a feeding tube?
Why ask it
Name his actual problems from the hospital therapists' notes instead of saying 'a stroke'. You are listening for a description of how they work with someone like him, down to who does it, and not a simple yes.
Having seen his hospital records, is there anything he needs that you could not provide here?
Why ask it
Dialysis, a tracheostomy, a lift for someone who cannot stand and one-to-one supervision for confusion are the kinds of thing that rule a place out. Better to hear it on the phone than on day three, so offer to have the hospital send the records before you tour.
Why would he do better here than in a skilled nursing facility's rehab wing, and is there anything they would do better?
Why ask it
Turn it around for the nursing facility and compare what each says about the other. The labels mean different things depending on the country and the insurer, so push past them to hours of therapy, how often a doctor comes and how long people stay.
What does he need to be able to do to be accepted, and who makes that call?
Why ask it
Intensive programs often want to see that a person can get through a set amount of therapy each day and is likely to gain from it, and the exact test depends on the facility and whoever is paying. If he falls short today, see whether he could be assessed again in a week or two.
How soon could you take him, and what do you need from the hospital before you can say yes?
Why ask it
Many centers send a nurse or liaison to read the chart and see the patient before accepting. Get that person's name and number and pass it to the hospital's case manager the same day, because a bed that is open this morning may not be tomorrow.
Can I watch the therapy gym for ten minutes while I am here?
Why ask it
Privacy rules may keep you at the doorway, which is enough. Count how many patients are working with a therapist and how many are sitting in wheelchairs waiting, and notice whether anyone there looks as affected as he is.
Therapy
How many minutes of therapy would he have each day, and on how many days a week?
Why ask it
Minutes are harder to round up than hours. In the United States the figure an inpatient rehab facility usually quotes is three hours a day on five days a week, and nursing facilities and other countries work differently. Whatever number you get, check whether it is a minimum or an average and what counts toward it: does time spent waiting or being wheeled to the gym?
Is every session one therapist with one patient, or is some of it group work or shared time?
Why ask it
Group sessions have their uses, especially for speech practice and morale. What you want is the split, in minutes, and whether the one-to-one time is protected when the unit is short of staff.
Who actually delivers the sessions: licensed therapists, therapy assistants or aides?
Why ask it
Titles and what each is licensed to do depend on where you live, so have them explain it for this building. A reasonable follow-up is how often the licensed therapist who wrote the plan sees him in person.
Will he keep the same physical, occupational and speech therapists for the whole stay?
Why ask it
For someone with aphasia or memory trouble, a new face every morning means starting over, and a therapist who knows him is the one who spots small gains. Staff schedules make some change unavoidable, so the real question is who covers and how they are briefed.
Is there therapy on Saturdays, Sundays and holidays?
Why ask it
A Friday admission can mean the first real session is on Monday. Check which disciplines work weekends, whether it is a full day or a short one, and what day of the week they would suggest he arrives.
Is a speech-language therapist here every day, and do they work on swallowing as well as on talking and understanding?
Why ask it
On some units the speech therapist's time goes mostly to swallowing checks, with little left for language. If communication is his main loss, pin down how many minutes a day would go to it and whether the family is shown how to practice with him.
How do you work on thinking, memory, attention and vision, and not only on walking and the arm?
Why ask it
These changes are easy to miss in a hospital bed and hard to miss at home. Ask which profession tests for them here, when in the stay that happens and how the results reach you, because a person can meet every walking goal and still not be safe alone in a kitchen.
What happens on a day when he is too tired or unwell for the full schedule?
Why ask it
Tiredness after a stroke can be heavy, and a good unit has a plan for it: shorter sessions spread out, a later start, work at the bedside. Check too whether missed days are reported to the insurer and can shorten the stay.
What equipment and methods do you use for stroke in particular, and how do you decide who gets them?
Why ask it
You may hear about body-weight support for walking, electrical stimulation, robotics or constraint therapy. No list tells you much on its own, so follow with how many patients were on that equipment last week and whether he would be a candidate.
What will he be doing between sessions and in the evenings?
Why ask it
Most of a rehab day is not therapy. Listen for whether nursing staff carry the practice on, having him walk to the bathroom and dress himself with help, or whether the hours between are spent in bed with the television on.
Doctors and nurses
Which doctor would be in charge of his care, what is their specialty, and how many days a week would they see him?
Why ask it
Rehabilitation medicine is its own specialty, and its name and training differ by country; in the United States the doctor is called a physiatrist. 'Daily' and 'when needed' are very different answers, so have them say which it is and whether a neurologist is involved too.
Is a doctor in the building at night and on weekends, or on call from somewhere else?
Why ask it
On call can mean ten minutes away or a phone consultation from home. The follow-up is who assesses a patient at 2 a.m. in the meantime, and what training that person has.
How many patients does one nurse have on the day shift, and how many after midnight?
Why ask it
Have them give last night's real numbers, not the target. Then the same again for aides, since they are the ones who answer a call light and help him to the toilet.
Do the nurses have specific training in rehabilitation or stroke nursing?
Why ask it
Some countries have a rehabilitation nursing credential, and you can find out how many of the staff hold it. Day to day, what counts is whether nurses continue what the therapists teach: the same way of moving him, the same care with his weak arm, the same swallowing rules.
If he showed signs of another stroke or became seriously ill, what would happen, and which hospital would he go to?
Why ask it
You want a fast, practiced answer that includes who makes the call and how the family is told. Two more things to check: whether his bed would be kept, and whether days in the hospital use up his approved stay.
Who teaches him and me about preventing another stroke: the new medicines, his blood pressure, the warning signs?
Why ask it
A rehab stay puts him near nurses every day for weeks, which makes it a better place to learn the pills than a leaflet at the door. Ask whether patients fill their own pill organizer before they leave, and whether a relative is shown how to take and write down a blood pressure.
How do you keep patients from falling without keeping them in bed?
Why ask it
Learning to move again carries risk, so a unit that claims no falls at all may be one where nobody is allowed up. Good answers are specific: supervised trips to the toilet on a schedule, alarms, low beds, and a clear position on restraints.
Who rechecks his swallowing, and how does every person who brings him food or pills know the current rules?
Why ask it
The plan is only as good as the least-informed person carrying a tray. See if the rules are posted at the bedside and what the kitchen receives, and if he is tube-fed, what the path back to eating looks like and who decides each step.
How do you handle bladder and bowel problems after a stroke: a toileting schedule and retraining, or mostly catheters and pads?
Why ask it
An awkward thing to raise, and it has a lot to do with how manageable home will be. Staffing shows here as well, because taking someone to the bathroom every few hours needs people, and pads do not.
How do you watch for low mood, anxiety or changes in behavior, and who treats them here?
Why ask it
A psychologist or neuropsychologist on the team is a different thing from a referral somewhere else, so get clear which this is. Tell them what he was like before the stroke, since staff who never met the old him cannot tell what has changed.
Goals and family
Who sets his goals, and are he and I in the room when that happens?
Why ask it
Goals written without the patient tend to read 'improve mobility'. Bring his own: getting up the three steps to the porch, reading to a grandchild, using his phone. Then see whether they turn up in the plan with a date beside them.
How do you measure progress, and how often would I see the numbers?
Why ask it
Most units score what a person can do at admission and repeat the scoring through the stay. Learn the name of the measure, have someone explain his starting score in ordinary words, and ask for it again each week so you watch the trend yourself.
How often does the whole team meet about him, and can I come or get a summary the same day?
Why ask it
Weekly is common, though each place sets its own rhythm. Since the discharge date is often set or moved at this meeting, ask how you can get a question into it beforehand and who phones you afterward.
Who is my single point of contact, and how quickly do they call back?
Why ask it
It is usually a case manager or social worker. Take the direct line and their working days, and settle now who the center will phone in the family, so that three relatives are not given three versions.
Can I sit in on his therapy sessions, and do visiting hours fit around the therapy schedule?
Why ask it
Watching sessions is how you learn what he can really do and how to help without doing it for him. A few therapists like a first week without an audience, which is reasonable as long as there is a point when you are invited in.
Would he have a room to himself, and can one of us stay overnight in the first few days?
Why ask it
A bad night shows up in the next morning's session, so a roommate's television or night-time care is worth asking about. If nobody may stay over, find out how the night staff check on a patient who wakes confused or cannot work the call button.
What hands-on training would I get before he comes home, and in which week does it begin?
Why ask it
A good answer comes as a schedule: named sessions with the physical, occupational and speech therapists and a nurse, starting by the middle of the stay. See whether they can be booked around your work hours, whether a second relative can be trained too, and whether someone watches you do each task before they call it done.
If he cannot speak or follow speech well, how do you include him in decisions about his own care?
Why ask it
Listen for picture boards, written choices, yes-or-no checks and extra time, and for the speech therapist being present at important conversations. A person with aphasia is easily talked over, and the answer shows whether the staff have noticed that.
What help is there for the family: a social worker, a caregiver group, someone who knows what we can apply for?
Why ask it
You are about to take on a job nobody trained you for. The benefits, leave from work and paid help available depend on where you live, so get the name of the person here who knows the local system and book time with them early.
Cost and stay
Do you take his insurance, and who gets the approval before he arrives?
Why ask it
Have the plan name and member number in front of you when you call. If approval is refused there is often a way to appeal, though how it works depends on the plan and the country, so ask who files it here, how long it tends to take, and whether the center's doctor will speak to the insurer's.
How long do stroke patients in his condition usually stay, and what decides the real date?
Why ask it
Expect a range and a reason. The date usually moves with progress, with what the insurer approves and with how ready home is, so ask which of those three most often ends a stay in this building.
How many rehab days does his plan allow, and will this stay use up days he might need later?
Why ask it
The admissions office usually checks his benefits before accepting him and can tell you what it found: a cap on days, a cap on dollars, or neither. Where there is a cap, a second stay or a nursing facility afterward may draw on the same allowance, so get the count in writing and confirm it with the plan yourself.
How often does the insurer review his stay, and what do you do when it declines more days?
Why ask it
Reviews can come every few days, and the notes the therapists write are what the reviewer reads. You need to know how much notice the family gets of a cut-off, what your right to challenge it is where you live, and whether he stays put while the challenge runs.
What would we pay ourselves, and what is billed separately from the daily rate?
Why ask it
Doctors' fees, equipment, the ride from the hospital and some medicines are the usual separate lines. Get an estimate on paper before admission, then phone the insurer and check the same figures from their side.
If he is not ready for home when the covered days run out, what are the choices?
Why ask it
The usual list is a move to a facility with less intensive therapy, going home with more help than planned, or paying privately for extra days. Get the private daily rate now, and the names of the places they most often send people on to.
Going home
When does planning for discharge start, and who is in charge of it?
Why ask it
'The day he arrives' is the answer to hope for. A named planner should be asking in the first week about stairs, the bathroom, who is at home during the day and what you can physically manage.
Will a therapist look at our home before he leaves, on a visit or from pictures we send?
Why ask it
An occupational therapist can tell you which door is too narrow and where a rail should go. If nobody visits, get the exact list of what to photograph and measure, and do it in week one so there is time to make changes.
Which equipment will he need at home, who orders it, and will it be there the day he arrives?
Why ask it
A wheelchair, a shower seat, a raised toilet seat or a hospital bed can each take days to arrive, and who pays varies. Get the list early with a name against each item, and try the wheelchair in your own car before discharge day.
Can he practice before the real thing: a day pass, a visit home, or a night in a training apartment with me doing the care?
Why ask it
A trial run shows what the gym cannot, such as the front step, the bed height and the 3 a.m. trip to the bathroom. Under some plans a pass affects insurance coverage, so check before you sign him out.
What therapy is arranged for after he leaves, and is the first appointment booked before discharge day?
Why ask it
The handover is where therapy can stall for weeks. Leave with a date, a provider's name and a phone number for each kind of therapy, and know whether it happens at home or at a clinic you have to get him to.
What will we take home in writing: the medicine list, the exercise program, the swallowing rules, the follow-up appointments?
Why ask it
See a blank or sample discharge packet now if they have one. On the day itself, go through it with a nurse line by line before the ride arrives, and check that the summary is also going to his family doctor and his neurologist.
Who do we call in the first week at home if something is not working?
Why ask it
Some centers phone a few days after discharge and some hand you a number, so ask which it is here. Also get straight which problems they want to hear about and which belong to his own doctor or to emergency services.
Can you assess whether he is ready to drive or go back to work, or send us to someone who can?
Why ask it
Neither may be on his mind yet, and for a younger survivor they can be the whole point of rehab. Some centers have a driving assessment and a vocational counselor in the building and many refer out. The rules on driving after a stroke are set where you live, so have the staff say which apply to him.
Do you follow your patients after discharge, and could he come back for another round if he gains or loses ground?
Why ask it
His needs will keep changing after the stay ends. A center with an outpatient clinic, a review appointment at a few months or a route to readmission gives you somewhere to go when a new problem shows up or a new goal becomes possible.
Choosing a stroke rehab center in a few days
Practical guidance for the conversation itself
Before you call a center
Learn the names for the levels of care
In the United States, 'acute rehab' or 'IRF' means an inpatient rehabilitation hospital or unit, and 'subacute' or 'SNF' means therapy inside a skilled nursing facility. Other countries have their own names for much the same split. Whenever a label comes up, have the speaker turn it into therapy minutes a day and doctor visits a week, which are the things you can compare.
Hear what the hospital therapists recommended
The hospital's physical, occupational and speech therapists usually write down what level of rehab they think he needs, and the centers and the insurer both read it. Have them tell you directly, in plain words, and say so if you think it undersells what he can do on a good day.
Learn how the list was made
The case manager or social worker on his hospital floor usually knows which centers have a bed and which have already been sent his file. Ask how the list was put together, whether the hospital is tied to any place on it, and how you add one that is missing. How much choice a family has depends on the country and the insurer, so have them explain it for your case.
Put his details on one page
The admissions person will want the date of the stroke, the hospital and floor, his insurance, and what he can do today: sit on the edge of the bed, stand with help, follow a two-step instruction, swallow. Add anything out of the ordinary, such as a feeding tube or dialysis. With that page in front of you a call takes ten minutes and ends in a yes, a no or a visit from their liaison.
Ask whose deadline it is
If you are told a choice is needed by this afternoon, ask whether that is the hospital's planning target or a fixed date from the insurer. A day can sometimes be found for a visit when the family says exactly what it is waiting on.
Making a short visit count
Arrive mid-morning on a weekday
That is when the gym should be at its busiest. An empty gym at 10 a.m. or a row of patients waiting their turn is information that no brochure carries, and so is a room full of people hard at work.
Look for someone like him
Rehab units treat hip replacements and spinal injuries too. See whether anyone in the gym has a weak side, a sling or a communication board, and how the staff speak to a patient who cannot answer quickly.
Stop one therapist and one nurse
Admissions staff describe the program as designed, and the people on the floor describe an ordinary Tuesday. Two minutes with each is enough: how many patients they have today, how many of those had a stroke, and what they wish families knew before choosing.
When you cannot get there
Many centers will do a video walk-through or send the liaison who visits the hospital to meet you at the bedside. Put the same questions to them, and if a relative or friend lives near the center, have that person stop by for a look.
Weighing one center against another
Seven lines on one sheet
Stroke admissions a year, therapy minutes a day, days a week, doctor visits a week, patients per nurse at night, the share who go home, the drive. Fill in a column for each center while you are still on the phone, because by evening the answers run together.
A rehab unit against a skilled nursing facility
The usual trade is intensity against time: more therapy each day over a shorter stay, or less each day over a longer one. Which suits him depends on what he can tolerate now, so take the question to the hospital therapists, and ask the insurer whether he could move up to the intensive unit later if he gets stronger.
Count the distance in training sessions
Family training happens in person, and a husband or wife who is there most days learns what a weekly visitor does not. Set a stronger program an hour and a half away against a decent one you can reach after work, and decide which you would honestly keep up for several weeks.
Give him the choice where you can
Show him photos of each gym and room and say what differs in two or three short sentences. Someone with aphasia can often still point, nod or pick between two written names, and a place he had a hand in choosing is easier to arrive at.
Answers that should slow you down
A therapy figure with no breakdown
'Three hours a day' can turn out to include group time, waiting and the trip down the corridor. A center that is confident in its figure can say how many of those minutes are one-to-one.
A promise about how far he will get
No one who has not yet treated him can know that he will walk out, and staff who say so are selling. The trustworthy version is what they would work on first and when they would be able to tell you more.
Nobody can name the doctor
If the person showing you around cannot say who leads the medical care or how often that doctor is on the unit, the medical cover may be thinner than the brochure suggests. Have the name and the schedule emailed to you before you decide.
Family teaching saved for the last afternoon
One demonstration on discharge day does not prepare anyone to move an adult safely from bed to chair. If training is described as something that happens 'before you leave', ask which week it starts and how many sessions other families got.