SAR is typically provided in a licensed skilled nursing facilty (SNF). Sometimes, SNFs are part of a hospital system and even physically located on the same campus, while other times, they’re independent organizations.
Regardless, an SNF must be licensed by the Centers for Medicare and Medicaid (CMS) in order to provide SAR. This licensing process includes regular onsite surveys to verify compliance with health regulations and life safety codes (such as fire protection and exit strategies).
SAR is typically paid for by Medicare or a Medicare Advantage program. Medicare is a federal insurance program that you pay into over the years as you work.
Medicare Advantage programs are private groups that essentially manage people who are eligible for Medicare but have opted to choose to be part of these groups.
Financial coverage and requirements vary, depending on which plan you have chosen.
Licensed physical, occupational and speech therapists provide therapy to increase your strength and functioning. For example, depending on what your need is, they might work to:
Increase your balance Improve your safety when walking Work to help you move your legs again after a stroke Improve your independence with activities of daily living (ADLs) Improve your cardio (heart) fitness after a heart attack
Licensed nursing staff provides medical care such as:
Wound management Pain management Respiratory care Other nursing services that must be provided or supervised by an RN or LPN
The goal of SAR is to provide time-limited assistance designed to improve functioning and safety at home or the previous place of living (such as an assisted living or independent living facility).
People receive SAR for a wide variety of conditions, including:
Joint (hip, knee, shoulder) fractures or replacements Cardiac conditions Stroke Diabetes Deconditioning related to a fall Chronic obstructive pulmonary disease (COPD) Congestive heart failure (CHF) Spinal cord injuries Amputation
Some people can only tolerate about 30 minutes a day at first, depending on their condition. Others may be able to tolerate multiple hours a day of therapy. SAR usually will provide up to about three hours of therapy per day.
If you’re at a SAR facility and feel as if you should be getting more therapy per day, you should ask your healthcare provider if your therapy minutes can be increased.
A variety of factors determine how long you might stay at a SAR facility, including:
The extent of your injuries or medical conditionYour overall healthHow long a stay your insurance approvesYour ability to live safely after you leave the SAR
A hospital, which is sometimes called “acute care,” is appropriate only for significant medical issues with the goal of a very short stay.
An acute rehab center is designed for high-level rehab needs, typically requiring more than three hours a day of physical, occupation, or speech therapy.
Centers for Medicare and Medicaid (CMS) provide a 5-star rating system on nursing homes, and many of those facilities provide SAR. Comparing the ratings of different facilities can be very helpful.
Typically, your most valuable resource will be recommendations from loved ones or friends who have already been through this process. Their personal experience is invaluable.
If you have time, it can also be helpful to stop by a few different facilities and ask for a tour. Watching the interactions of the staff with the patients can be an important indicator of the quality of care provided.
Remember that even though some buildings can look brand new, it’s the program and people caring for you that really will influence your experience there.
Hospitals frequently will steer you toward their own SAR programs if they are affiliated with one. And, while this may be a good option, you do have a right to decide where you would like to rehab.
Your options may, however, be limited by whether your insurance classifies the facilities you choose as in or out of network, and whether those facilities choose to accept you into their program.
If the healthcare provider feels strongly that you are not safe to leave yet and you choose to leave anyway, they will likely ask you to sign a form that says you are leaving against medical advice (AMA).
This means that although they can’t make you stay, they don’t believe you’re safe to go home yet. It’s protection for the facility because, without that documentation, they could be liable for harm that occurred because of your early discharge.
Once it’s been decided that your SAR coverage is ending, you must receive advance notice of this denial of coverage.
This is sometimes called a “cut letter” or “denial notice,” and a copy must be provided to you and kept on file at the facility to prove that you were given notice of this change before it occurred.
Coverage might end for a variety of reasons, including:
You no longer require skilled therapy or skilled nursing services You’re not able to participate in the therapy services (such as if your memory is impaired by dementia) You continuously choose not to participate in therapy services You’ve used up your allotted number of days for SAR
While you may be eager to go home, it’s also possible that you could be very concerned that you’re not strong enough yet to go home.
If you feel that your insurance coverage should not be ending yet, you are allowed to appeal this denial of coverage. You can request an expedited appeal so that you will have an answer quickly.
Directions for appealing will be included in the denial of coverage notice that you receive.
If you choose to appeal, the facility will provide the insurance company with your relevant clinical information and they will approve or deny your appeal for additional SAR coverage.
The SAR social worker will help you look at other options which may include transitioning to a skilled nursing facility, like assisted living or an adult foster care home.
They may also be able to work with your family members and community agencies to provide additional assistance at home to increase the safety of this option.
Remember that some people do take longer to heal and regain functioning than others, so it’s important that you continue to work to maintain and improve your strength, wherever you live.
For example, you might still be able to receive a lesser level of therapy services through Medicare Part B at a skilled nursing home which may make it possible to return home in the future as you slowly gain functioning.
However, since many insurance companies try to limit the costs that they pay out for their clients, a more practical goal at SAR may be to help you be safe and strong enough to go back to your home and then continue rehab there.
Before you’re discharged from SAR, the facility should provide referrals and make arrangements for you to receive ongoing care such as home health services, provided you agree to these support services.
Home health care agencies can assist you at home with physical therapy, occupational therapy, speech therapy, professional nursing care, and medical social work services.
Using these community resources can help you successfully transition back home, which is the shared goal of both you and the SAR staff who have been working with you.
