Rehabilitation facilities
Description
Most people hope to go directly home from the hospital after knee-replacement surgery. You should talk about this issue with your doctors and nurses in the weeks before your knee replacement. They can advise you about whether going directly home is good for you.
If you are weak before the surgery, you and your doctor may plan ahead of time for you to stay in a skilled nursing facility.
Even if you and your doctor planned for you to go home, your recovery may be slower than expected. When you no longer need to be in the hospital, the hospital will discharge you so that you can go to a place that can give you the right care. As a result, you may need to go to a skilled nursing facility.
Skilled nursing facilities provide care for people who can't yet care for themselves at home, but who can be discharged from the hospital after knee replacement. The goal is for you to return home and care for yourself.
It is important to plan where you would like to go before you have your surgery. This will help ensure that you go to a place that provides quality care and is located in a place that works best for you.
Take these steps also:
- Choose second and third choice options. If there is no bed available in your first choice skilled nursing facility the hospital still needs to transfer you to another qualified facility.
- Make sure the hospital knows about the places you have chosen and the order of your choices.
Who needs to go to a skilled nursing or rehabilitation facility?
When it is time to leave the hospital, you may still not be ready to go home. You may need to spend time at a skilled nursing or rehabilitation facility between leaving the hospital and going home.
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 safely without needing much help.
- Walk around enough that you will be able to safely move between where you are sleeping to your bathroom and kitchen.
- Go up and down stairs, if there is no other way to avoid them.
- Able to bend the knee enough to have appropriate progress.
Other factors that may prevent you from going directly home from the hospital:
- Your surgery may be more complicated.
- 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 problems will prevent you from going right home.
- Other medical problems, such as diabetes, lung problems, and heart problems, have slowed down your recovery.
- You are not progressing as quickly with your physical therapy.
Choosing the right facility for you
While a doctor will supervise your care, other trained health professionals will help you grow stronger:
- Registered nurses will care for your wound, give you the correct medicine, and help monitor other medical problems.
- Physical therapists will teach you how to make your muscles stronger and get up from and sit down on a chair, toilet, or bed. They will also teach you how to climb steps, keep your balance, and use your walker, cane, or crutches.
It is always a good idea to check out different skilled nursing facilities that you would like to go to. Visit 2 or 3 facilities and choose more than one facility at which you would be comfortable.
Important factors in the facilities you choose will include:
- Quality of care
- Where the facility is located
- How well it is decorated and maintained
- What the meals are like
Keep in mind that your most important goal is to get safely back in your home. The quality of care you will receive at this facility plays the biggest role in getting you home as quickly as possible.
When looking into the facilities that are near you or those suggested to you by friends or the hospital, find out about the following:
- Do they take care of many people who have had a knee replacement? Can they tell you how many? A good facility should be able to show you data that shows they provide good quality care.
- Ask whether they have physical therapists that work at the skilled nursing facility. Make sure the therapists have experience helping people after knee replacement. Ask whether you will see the same 1 or 2 therapists most days.
- Do they have a plan (also called a pathway or protocol) for taking care of patients after knee replacement?
- Do they provide therapy every day, including Saturday and Sunday? How long do the 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 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 do this teaching.
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 Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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