Essential Questions for Rehab Facility Admission Assessment
Upon admission to a rehabilitation facility, you must conduct a comprehensive initial assessment that includes functional status, medical stability, psychosocial factors, and rehabilitation goals to establish an individualized treatment plan and predict discharge needs. 1
Core Assessment Domains
Medical and Functional History
Current functional status and baseline function: Document the patient's current level of independence in activities of daily living (ADLs) and compare to their pre-morbid functional status to establish rehabilitation potential 1
Neurological deficits: Perform a detailed neurological assessment of residual impairments, including motor, sensory, cognitive, and communication deficits 1
Medical comorbidities: Identify all active medical conditions that may impact rehabilitation participation or require ongoing management, including diabetes, cardiac disease, and chronic pain 1
Medication review: Document all current medications with specific attention to timing of administration, relationship to meals, and any required adjustments for exercise or therapy participation 1
Exercise Capacity and Physical Tolerance
Ability to participate in therapy: Determine if the patient can tolerate at least 3 hours of therapy per day, 5 days per week, which is the standard requirement for inpatient rehabilitation facility admission 1
Exercise capacity assessment: Evaluate maximal or submaximal exercise capacity using standardized methods to establish baseline and guide exercise prescription 1
Risk stratification: For cardiac patients, assess for high-risk features that may predispose to exercise-induced complications 1
Psychosocial and Mental Health Assessment
Depression screening: Use a valid and reliable screening tool to assess for depression, as it is highly prevalent (20-45%) in rehabilitation populations and significantly impacts outcomes 1
Readiness to change: Assess the patient's motivation and readiness to participate in rehabilitation, particularly regarding modifiable risk factors like smoking 1
Barriers to adherence: Identify potential barriers including medical complications, mental health factors, or lack of understanding about diagnosis, prognosis, and treatment rationale 1
Home Environment and Support System
Living situation: Document where the patient lives and with whom, as spousal support and well-functioning family units predict better outcomes 1
Caregiver availability and capability: Assess whether family or caregivers are available, knowledgeable about the patient's condition, not depressed themselves, and capable of providing necessary assistance 1
Home accessibility: Determine if the home environment can support the patient's functional deficits or if modifications (ramps, equipment) will be needed 1
Community resources: Evaluate access to community support services including home health, Meals-on-Wheels, transportation, and outpatient therapy facilities 1
Vocational and Leisure Goals
Employment status and work history: For working-age patients, conduct a comprehensive work assessment including current employment status, physical and cognitive job demands, organizational role, workplace flexibility, and access to paid sick leave 1
Return-to-work goals: Document the patient's goals for working during and after rehabilitation, as employment is a critical quality-of-life outcome 1
Leisure activities and interests: Ask about participation in leisure and recreational activities, as these are closely related to health status and quality of life and may provide motivation for rehabilitation 1
Specific Medical Conditions
For diabetic patients, additional questions are critical 1:
- Type of diabetes and differentiation between type 1 and insulin-requiring type 2
- Nutritional history including foods avoided for spiritual, allergic, or other reasons
- Timing of medications relative to meals and snacks
- Routine changes in diet or medication for exercise
- Frequency of ketoacidosis and hypoglycemia episodes
- History of severe hypoglycemia without awareness requiring assistance
- Known chronic complications and date of last dilated retinal examination
For cardiac patients, assess 1:
- Smoking status and tobacco use (never smoked, former smoker, current smoker)
- Amount and duration of smoking
- Exposure to second-hand smoke at home and work
- Blood glucose control (fasting plasma glucose and HbA1c)
Communication Technique
Use open-ended questions: Begin with open-ended phrases like "What questions do you have?" rather than closed-ended questions like "Do you have any questions?" to elicit more information and patient concerns 2, 3
Allow free discussion: Open-ended questions that allow patients to discuss concerns freely are positively related to the amount of information obtained (p < 0.0001) 2
Goal Setting and Discharge Planning
Establish rehabilitation goals: Work with the patient to set specific, measurable functional goals based on their priorities and anticipated discharge environment 1
Anticipate discharge needs: Determine early whether the patient will require skilled nursing care, regular physician contact, or can be managed with caregiver support and community services 1
Plan for post-discharge services: Assess whether continued therapy will be needed and if the patient can tolerate outpatient services or requires home-based rehabilitation 1
Critical Pitfalls to Avoid
Missing depression: Depression is an independent risk factor for poor outcomes and mortality; failure to screen and treat significantly compromises rehabilitation success 1
Inadequate caregiver assessment: Discharge failures often occur when caregiver capability is overestimated or support systems are inadequate 1
Ignoring vocational goals: For working-age patients, failure to address employment concerns early leads to worse quality-of-life outcomes 1
Incomplete medication reconciliation: Particularly for diabetic patients, errors in insulin timing or exercise adjustments can lead to dangerous hypoglycemia 1