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Skilled nursing facilities after joint replacement

Most people hope to go home directly from the hospital after surgery to replace a joint. Even if you and your health care provider 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 providers 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 a few facilities that 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.

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Who Needs to Go to a Skilled Nursing or Rehabilitation Facility?

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

• Safely get around using a 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 in your home, such as between where you sleep, your bathroom, and your kitchen.
• Go up and down stairs, if there is no 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 your living condition, 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

At a facility, a provider will supervise your care. Other trained providers will help you grow stronger, including:

• 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 a 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 2 or 3 facilities. Choose more than one facility at which you would be comfortable. When visiting, ask the staff questions such as:

• Do they care for 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 the same 1 or 2 therapists treat you most days?
• Do they have a plan (also called a pathway, or protocol) for taking care of people 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 provider or your orthopedic surgeon does not visit the facility, will there be a provider in charge of your care? How often does that provider check in with you?
• 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

American Association of Hip and Knee Surgeons website. Going home after surgery. hipknee.aahks.org/wp-content/uploads/2019/01/going-home-after-surgery-and-research-summaries-AAHKS.pdf. Updated 2018. Accessed August 17, 2023.

Cuccurullo SJ, Joki J, Luke O. Introduction to physical medicine and rehabilitation. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 41.

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Review Date: 8/12/2023  

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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