An inpatient rehabilitation hospital is a facility where patients recovering from a serious illness, injury or surgery live for a period of time while receiving intensive therapy from a coordinated team. Medicare calls these settings inpatient rehabilitation facilities (IRFs). The goal of an IRF stay is to help a patient regain as much function and independence as possible, such as walking, dressing, swallowing, speaking and managing daily routines, so they can return home or to the community.
This guide is general information, not medical advice. Your doctors and the hospital's discharge planners can tell you which option fits a specific situation.
Freestanding rehab hospitals and rehab units
An IRF can take two forms:
- Freestanding rehabilitation hospitals are separate hospitals devoted entirely to rehabilitation.
- Rehabilitation units are distinct units inside a general acute care hospital. Medicare treats a qualifying unit as its own IRF, with its own rules, staffing and payment, even though it shares a building with the rest of the hospital.
Both types must meet the same Medicare requirements to be paid as an IRF. CMS also requires that a set share of an IRF's patients, commonly called the 60 percent rule, have one of a list of conditions that typically need intensive inpatient rehabilitation.
Who qualifies for inpatient rehabilitation
Medicare covers an IRF stay when a patient needs, and can take part in, an intensive and coordinated rehabilitation program. The CMS criteria generally include:
- Intensive therapy. The patient is expected to need and tolerate an intensive program, commonly described as about 3 hours of therapy a day, at least 5 days a week. In some cases the schedule is measured as at least 15 hours over 7 days.
- More than one therapy discipline. Care involves physical therapy, occupational therapy, speech-language pathology or prosthetics and orthotics, with physical or occupational therapy as one of them.
- Physician supervision. A physician with training or experience in rehabilitation oversees care and sees the patient face to face regularly during the stay.
- An interdisciplinary team. Doctors, rehabilitation nurses, therapists and social workers or case managers meet regularly to review progress and adjust goals.
- Expected benefit. The patient is expected to make measurable improvement within a reasonable period of time.
A patient who is too ill or too weak to participate in several hours of therapy a day may be referred to a different setting first.
Common conditions treated
IRFs commonly care for people recovering from:
- Stroke
- Brain injury, including traumatic brain injury
- Spinal cord injury
- Amputation
- Hip fracture
- Major multiple trauma, such as injuries from a serious car crash
- Neurological conditions, such as multiple sclerosis, Parkinson's disease and Guillain-Barré syndrome
Some IRFs also treat severe burns and certain joint replacements, and many run dedicated programs for a single condition, such as stroke.
IRF vs skilled nursing facility vs home health
| Inpatient rehabilitation facility (IRF) | Skilled nursing facility (SNF) | Home health | |
|---|---|---|---|
| Where care happens | Hospital or hospital unit | Nursing facility, sometimes a unit within a hospital | Patient's home |
| Therapy intensity | Intensive, commonly about 3 hours a day, at least 5 days a week | Less intensive, set by the patient's needs | Intermittent visits |
| Physician involvement | Rehabilitation physician supervises care with regular face-to-face visits | Physician oversight with less frequent visits | Physician or allowed practitioner certifies and reviews the plan of care |
| Typical patient | Can tolerate and benefit from intensive therapy | Needs daily skilled nursing or therapy but not hospital-level rehabilitation | Homebound and needs part-time skilled care |
| Prior hospital stay for Medicare | Not required | Generally a qualifying 3-day inpatient stay | Not required |
The right setting depends on medical needs, stamina, home support and insurance. Some patients move through more than one, for example from an IRF to home health.
Medicare coverage in general terms
Medicare Part A covers medically necessary inpatient rehabilitation care in an IRF, including a semi-private room, meals, nursing, therapy and drugs given as part of inpatient care. Part A deductibles and coinsurance apply under the same benefit period rules used for other inpatient hospital stays. Unlike skilled nursing facility care, Medicare does not require a prior 3-day hospital stay for IRF coverage.
If you came directly from an acute care hospital in the same benefit period, you generally do not pay a second Part A deductible. Medicare Advantage plans often require prior authorization. Check current cost-sharing amounts on Medicare.gov or with your plan. For help with costs, see Hospital Financial Assistance.
How to choose an inpatient rehabilitation hospital
You often have more say in choosing a rehab facility than an emergency hospital. Useful sources include:
- Medicare.gov Care Compare. CMS publishes quality measures for IRFs, including discharge to community, which shows how often patients go home without an unplanned readmission or death shortly after leaving, and functional improvement measures, which show how much patients gained in self-care and mobility. Other measures cover falls with major injury, pressure injuries and readmissions.
- Experience with your condition. Ask how many patients with your diagnosis the facility treats and whether it has a dedicated program.
- Insurance network. Confirm the facility accepts your plan.
Browse rehabilitation hospitals by state or find hospitals near me. For broader context, read Types of Hospitals and How to Choose a Hospital.
Questions to ask before admission
- How many hours of therapy will I receive each day, and on which days?
- Which therapists will be on my team, and how often will I see the rehabilitation physician?
- What is the expected length of stay, and how will discharge be decided?
- Will family members be trained to help at home?