How to request rehab after knee replacement?

12 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
12 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
12 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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I personally don't feel that your question is out of line. Your doctor/surgeon, of course, should cover everything with you, including all the post-surgery stuff. Pepper him/her with all your questions! My own experience amounted to two partial replacements done several months apart about five years ago. Yes, my surgeon asked me if I wanted them done at the same time, but I had a hard time imagining being off both legs at the same time. Each episode amounted to a couple of days in the hospital before going home. Yes, you probably will need some hefty pain-killers for awhile. I was sent home with a contraption that automatically bent and straightened the leg. After a week or two, it was physical therapy sessions, twice a week, for a couple of months. Those sessions were super-painful as the primary purpose is to attain full range of motion, both bending and straightening. I'd say that if tears do not come to your eyes, then you aren't putting as much into it as you should. Anyway, for me, the physical therapy was the hardest, but most important, phase of the whole experience. Since you are alone, your doctor should be able to inform you of services available to you that will enable you to recover properly. For the first month or so, you won't be able to drive, so you'll need assistance from a friend, neighbor, or some kind of paratransit service. There is another possibility that might come into play in your particular situation, but I'm not an authority in this area so check with your doctor. Upon your discharge from the hospital, the doctor may feel that your situation (living alone) warrants a brief stay in a rehab facility. The rehab facility would have physical therapists to help with that part of your recovery, and they would also teach you how to continue your progress at home alone. The length of your stay would be dependent on a determination by the rehab facility that you are capable enough to take care of yourself at home. Again, this part should be covered by your doctor and your medical insurance coverage also is pertinent. One more thing. My surgeon cautioned me not to engage in vigorous activities with the new knee. While I realize that medical advances and perhaps newer knee materials mean that your new knee will be much more durable than mine, most doctors five years ago were saying that you don't want to wear out or damage that replacement. Apparently, a second replacement was highly problematic. They don't last forever, and that weighs against doing knee replacements on younger patients. Again, things may have changed since then. Anyway, I was told: no running, brisk walking was okay, swimming would be great. While those cautions came as a big disappointment to me, the pain-free existence since then has been all worth it. Let me stop here and pass the ball back to you. Of course, everyone's experience and situation is different, so please consider what others say as well.
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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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I was my Dad's primary caregiver through two recent TKRs. The first was May 2012; the second was 5-months later - SAME KNEE. The first TKR resulted in worsening pain; no amount of PT would have helped. The prosthesis was the wrong size, and not aligned properly. (It was done by an experienced, board-certified surgeon who is the director of Joint Replacement at the hospital.) My Dad is still recovering from his October 2012 surgery (different surgeon) - VERY SLOWLY, but we have to keep in mind that he is recovering from the trauma of TWO surgeries. My point is (similar to sephia) is to be fully informed ahead of time. The Bonesmart website has been an invaluable source of information, and is a great support group. The above cases are "exceptions". I have heard and read about many successful outcomes, and I wish you the best. Please keep us posted. Here is a link that might be useful: Bonesmart
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maire_cate
12 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
12 years ago
I'd prefer to stay out of institutions and have PT at home.
bee0hio
12 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
12 years ago
Your ortho should give the order for rehab. Mine does.
phoggie
12 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
12 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
12 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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