Introduction

Most people hope to go directly home from the hospital after major joint-replacement surgery (shoulder, hip, knee, or ankle). You should talk about this issue with your doctors and nurses in the weeks before your joint replacement. They can advise you about whether going directly home is good for you.

If you are weak before surgery, you and your doctor may plan on you staying in a skilled nursing facility ahead of time.

Even if you and your doctor planned for you to go home after surgery, your recovery may be slower than expected. When you no longer need to be in the hospital, the hospital will discharge you so that you can go to a place that can give you the right care. As a result, you may need to be transferred to a skilled nursing facility.

Skilled nursing facilities provide care for people who are not yet able to care for themselves at home but can be discharged from the hospital after joint replacement. The goal is for you to return home and care for yourself.

It is important to plan where you would like to go before you have your surgery so you can go to a place that provides quality care and is located in a place that works best for you.

Take these steps also:

Find second and third choice options. If there is no bed available in your first choice skilled nursing facility, the hospital still needs to transfer you to another qualified facility.
Make sure the hospital knows about the places you have chosen and the order of your choices

Who Needs to Go to a Skilled Nursing or rRhabilitation Facility?

When it is time to leave the hospital, you may still not be ready to go home. You may need to spend time at a skilled nursing or rehabilitation facility between leaving the hospital and going home.

Before you can go home after surgery, you must be able to:

Safely use your cane, walker, or crutches
Get in and out of a chair and bed without needing much help
Walk around enough that you will be able to move safely between where you are sleeping and your bathroom and kitchen
Go up and down stairs, if there is no other way to avoid them

Other factors may also prevent you from going directly home from the hospital:

Your surgery may be more complicated.
Because of where you live, you need to be stronger or more mobile before going home.
Sometimes infections, problems with your surgical wound, or other medical problems will prevent you from going right home.
Other medical problems, such as diabetes, lung problems, and heart problems, have slowed down your recovery.

Choosing the Right Facility for You

While a doctor will supervise your care, other trained health professionals will be helping you grow stronger:

Registered nurses will care for your wound, give you the correct medications, and help monitor other medical problems.
Physical therapists will teach you how to make your muscles stronger and get up and sit down from a chair, toilet, or bed. They will also teach you how to climb steps, keep your balance, and use your walker, cane, or crutches.

It is always a good idea to check out different skilled nursing facilities that you would like to go to. Visit two or three facilities and choose more than one facility at which you would be comfortable.

Important factors in the facilities you choose will include where the facility is located, how well it is decorated and maintained, what the meals are like, along with many others.

Keep in mind that your most important goal is to get safely back in your home. The quality of care you will receive at this facility plays the biggest role in getting you home as quickly as possible.

Therefore, when looking into the facilities that are near you or those suggested to you by friends or the hospital, find out about the following:

Do they take care of many people who have had a joint replacement? Can they tell you how many? A good facility should be able to show you data that shows they provide good quality care.
Ask whether they have physical therapists that work at the skilled nursing facility. Make sure the therapists have experience helping people after joint replacement. Ask whether you will see the same one or two therapists most days.
Do they have a plan (also called a pathway or protocol) for taking care of patients after joint replacement?
Do they provide therapy every day, including Saturday and Sunday? How long do the therapy sessions last?
If your primary care doctor or your orthopedic surgeon does not visit the facility, will there be a doctor in charge of your care?
A good facility will take the time to teach you and your family or caregivers about the care you will need in your home after you leave the facility. Ask how and when they do this teaching.

References

Dejong G, Horn SD, Smout RJ, Tian W, Putman K, et al. Joint replacement rehabilitation outcomes on discharge from skilled nursing facilities and inpatient rehabilitation facilities. Arch Phys Med Rehabil. 2009 Aug;90(8):1284-96.

Reviewed By

Review Date: 08/12/2011

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, and Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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