How to request rehab after knee replacement?

10 years ago

I'm having a total knee replacement in a month. Everything I've read seems to indicate that a person who goes to a rehab facility for a week instead of just going home does far better. Apparently they make you go to therapy 3 times a day. I do have a husband who would pamper me if I go home. He has had both knees replaced. He had a therapist come to the house twice a week for the first few weeks, and then he went to a local PT. But he is not as lazy as I am and actually did more than was required. I have Medicare and Blue Cross/Blue Shield which would likely pay. Is it something I can ask for or does the doctor do it? My sister who lives alone in another state did go to a rehab facility for 5 days after hers and did well.

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Comments (9)

sephia
10 years ago
I had a total knee replacement Sept. 2012. I have the same insurance that you do - Blue Cross/Blue Shield. I went to a rehab facility after my surgery for a week. It was the best think I ever did. I just told the hospital when I made my pre-op surgery arrangements that I was going to this particular facility, and they were actually glad. I went to the rehab facility a few days before the surgery to check it out, then I made the arrangements with them about when I would get there (approximately), and they did all the paperwork and contacted my insurance to make sure it was covered.
bee0hio
10 years ago
Do you have a Rehab facility or a Skilled Nursing Facility (SNF) in your area? The difference is basically the intensity of the therapy. Either of these might be associated with a hospital or with a nursing home type of facility. Maybe even the hospital where you're having the surgery?

You might want to tour any prospective facilities to help with your decision. CARF accreditation is something to look for in a Rehab facility. For SNF be sure it is Medicare licensed. Speak to the person in charge of admissions. If you're having *total* knee you'll probably stay in the hospital 2-4 overnights ("partial" knees stay usually just 1 night). You need 3 overnights to qualify for Medicare SNF.

The surgery hospital will have a discharge planner or case manager that will meet with you & help you figure out the appropriate discharge plan for your situation. It's a good idea to have things in mind ahead of time. Your surgeon or the hospital should have a whole packet of information (pathway) telling you ALL about what to expect & how to prepare.

Hope this helps.
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Well, I did it! Or rather my orthopedic surgeon did. Dr. Pontius gave me a total knee replacement almost five weeks ago. After spending five days in the hospital I came home to the excellent care of my hubby, Bob, instead of going to a rehab facility. The after care provided was very complete and well organized, and I'm told is cheaper for the insurance company than going to rehab. I had RNs, LVNs, a caregiver that helped me shower, and physical therapists in and out of our home almost daily. While there is a lot of discomfort the first two or three weeks round the clock pain meds are provided to take the edge off. Interestingly the anesthesiologist gives you something like a massive novicain injection in the thigh area before surgery (you are 'out' when he does it) which totally negates any severe pain. It lasts for several days allowing you to start physical therapy by walking around your hospital room the day after surgery. I am now walking without a walker or a cane (not very fast, but I'm walking) and I even went outside to water the plants yesterday, as well as going to Olive Garden for lunch with Bob and visiting my daughter where she works. Yes, there is a lot of exercises that must be done a couple of times daily. Some I do almost continually such as scrunching the knee cap muscles while sitting in a recliner as well as moving both legs around and working the feet up and down. At first the therapy is not easy and you think you are never going to be able to extend the knee, but it's amazing how quickly you find that movment works through and lessens the stiffness and soreness. I'm still taking pain meds, but am going longer between doses. A couple of tips I can think of right now: Be sure you get the same pain meds that were working well for you in the hospital. My prescription was initially filled with a generic and it was not the same! I had the ice machine at the hospital and it was wonderful, but one of those pleated ice bags works very well also. We went through a lot of bags of crushed ice before I thought of using a mini ice chest to keep the it in between uses. My drinking water bottle was kept cool in it as well. Elastic compression hose work great to keep the swelling down. I'm still wearing it in the daytime. You may be able to bring them home from the hospital, but if not buy some. Well, that's about it. So far so good. Of course there are certain risks with any major surgery. If the rare complication occurs recovery might take a little longer, but they are taken care of. Whatever, the modern miracle of knee replacement sure beats the alternative of limping around with knee braces and a cane or walker the rest of your life. Happy gardening everybody!
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I had my first knee replacement 19 years ago. At that time, when you woke up from the surgery, your leg was in a CPM machine (continues passive motion) and I have wondered if that is still in use now? Did you have it? After the surgery, it was routine to go right to Skilled Care, in-house, for 10 days .OH! The torture! and then home. The CPM went home with you. I've forgotten all the details, but the CPM was to be used a certain number of hours a day . It was painful, but appreciated, because very few if any, would get that much exercise otherwise. It stayed hooked up on my bed, and I could put myself in and out of it by myself. I used it a lot at night, and believe it or not, I did sleep quite a bit with it on. At home, it was my choice to stay by myself. (My DH died in 1982) I preferred to rest, eat, and sleep whenever I chose to, and not have to be disturbed. Family and friends made sure I had food, and all required goodies, and came by from time to time in the early evenings. Six weeks following surgery it was physical therapy at the gym. Had the second knee done ten years later. Same routine. Ice packs? Before you have the surgery get a couple large bags of frozen peas, and put them in the freezer, ready on demand. Doctor recommended. After all these years my knees do cause pain, but without that surgery I probably would be in a wheel chair. Hang tough! maire_cate, just read your post. When I had my first one, I asked the surgeon to do both; he wouldn't, and back then no other surgeon would either. You did really well. Sue
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ALLEUIA,this is the first i've been able to get on here in several days,since i posted that question about the security alert.After i posted that,i could never get back here til now.I was having severe withdrawl symptoms!!LOL Anyway,i need to have knee surgery,and have needed it for the past few years.Dr has suggested that i wait awhile as it really doesn't last for the rest of your life.So i have done that,but am seriously considering having it done this spring.I too have arthritis in my knees,and i'll be 70 in March. My ds had it maybe 5 years ago,but his knees were worse than mine due to motorcycle/dirtbike racing.He got the knees from a cadaver and is doing very well.His recovery was super fast,He had it done on a thursday and went back to work on Monday,at first in a wheel chair for a couple days,then on crutches.He never went to rehab,instead he had some contraption set up in his bedroom at home as he told his dr,i have a businees to run,and don't have time to be running to someplace for therapy,so they got him set up and he did very well.Now you would never know he had knee problems. My sons dr and my dr both told me i should start exercising my legs now to get them strong before the surgery as that will make the recovery shorter and less painful.So ds is going to bring me his stationary bike and set it up in my sewing room.Yipee!! Not,LOL Kathi
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maire_cate
10 years ago
Bee's right. Your hospital or surgeon should give you a packet of info so you know what to expect. You can call and request one now. Additionally my hospital had a mandatory 2 hour class that I had to attend 2 weeks ahead of time. That gave me the opportunity to ask more questions. The hospital social worker also wanted to know if I had stairs at home and how many, if I lived alone or if I had a family member or someone to assist me.

I'm not on Medicare yet so I don't know what they cover and not all private insurance plans will pay for in-patient, hospital based rehab for only one knee. Why not call and ask so that there aren't any surprises after surgery? You'll feel better knowing what to expect.

Last May I had both knees replaced at the same time. I was in the hospital from Monday to Friday and then transferred to a hospital based rehab center near my home for an additional week. Then I had at home PT three times a week for one month and then after that I had 3 months of out patient PT.

My neighbor is having one knee replaced next week. She isn't on Medicare but does have good insurance since her DH is a physician and she'll remain in her hospital for 1 to 2 days post op and then will be discharged home. She'll have in home PT and then out patient PT.
chisue
10 years ago
I'd prefer to stay out of institutions and have PT at home.
bee0hio
10 years ago
I would agree with you, Chisue. Less risk of postoperative infections. My DH had knee replacement last june and he went to outpatient PT and also had home exercises per their instructions. He did extremely well in his rehab and recovery.
monica_pa Grieves
10 years ago
Your ortho should give the order for rehab. Mine does.
phoggie
10 years ago
An important thing...start doing PT now two times a day in your own home...you need to get those muscles in shape before surgery.

After my three replacements, I went to the local PT facility 2-3 times a week, but did the exercises twice a day by myself at home also. I tend to stay away from the hospital/nursing home settings.

Good luck...now go get on your bed and get those leg lifts started!
breenthumb
10 years ago
I had a total hip replacement in July and did go to a rehab facility, which was great, The hospital social worker asked me for my 1st, 2nd, and 3rd choice. Then its up to which one has room at the time of discharge. What I did beforehand was check out a few of the nearby places I was considering. Two friends had done rehab at one of them right in the neighborhood and highly recommended it. It made me claustrophobic.

My surgery was scheduled quickly, so I didn't make formal appointments, just kind of popped in when I could (usually late afternoon, not a busy time for them) just to get a feel for what they were like. They were all good enough to give me a short tour... the rooms for short term rehab, the exercise room, and I asked about meals--where do we eat, the type of menu. I did fill in an application for "the one" I really wanted, and when the SW contacted them, they had a room so I got my 1st choice.

I also have Medicare and BCBS. There was a $50/day copay for rehab that Medicare doesn't cover. Came as a surprise, but the place was sooo worth that and more. Doesn't seem to matter if you pick the most or least expensive, the copay is the same. And there is really very little price difference between them!

The visiting nurse and PT come to your house when you go home, whether its right from the hospital or do rehab first. You'll do fine.
pekemom
10 years ago
I had a total left knee replacement last Oct. After the hospital I went to the skilled nursing facily across the street for another 5 days, they wanted to make sure I could take care of myself since my husband has his own health problems and couldn't help much. The day after I got home the PT started coming over, everyday for over a week, maybe 2, I don't remember, but they came to the house, I didn't go to any facility for therapy. Occupational therapy came a few times, nurses every few days.

How to request rehab after knee replacement?

Comments (9)

sephia

bee0hio

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