Inpatient rehabilitation is intended for patients who, due to their stroke, have significantly impaired functioning and are unable to return to their homes but require intensive rehabilitation in a centre or rehabilitation ward. The rehabilitation wards have rehabilitation medical teams, nursing teams, as well as treatments from the health professions – occupational therapy, physiotherapy, speech therapy, rehabilitative psychology, social work, nutrition. The patients receive rehabilitative treatment five days a week, and continuous medical and nursing care.

The goal of inpatient rehabilitation is to assess the new physical impairments and difficulties, to prevent worsening of the functional condition and to improve it as much as possible – by treatment and by adjustment of auxiliary devices, together with emotional and social support for the patient and his family. In addition, in many cases it is necessary to prepare and make accessible a living environment and/or to obtain the assistance of a permanent caregiver so that the patient can be released back into the community (home or institution). 

The duration of the rehabilitation period is determined by the rehabilitation teams and depends on the patient’s progress in relation to the objectives of the rehabilitation. The average hospitalisation time after a stroke is about two months. The time may be longer or shorter, depending on the recommendations of the interdisciplinary team and subject to the approval of the sick fund.

Usually when there is a need for inpatient rehabilitation and the patient is 65 years of age or older, the rehabilitation will take place in the geriatric rehabilitation ward (see the “Right to Rehabilitation” page).

The conditions for referral for inpatient rehabilitation

• When there has been a significant and sharp functional decline as a result of the stroke.
• When the patient has rehabilitation potential;  in other words – a reasonable possibility of achieving functional improvement as a result of rehabilitation treatment according to the decision of a rehabilitation doctor (or a geriatrician in patients over the age of 65).
• When the patient’s medical condition requires medical supervision and nursing care.
• When the family, social and environmental conditions of the patients do not allow for treatment at home or in the community, for example when there is no primary caregiver, or reasonable living conditions, etc.
• When functional impairments require intensive treatment and means that are found only in hospitalisation settings (such as the need to use advanced technology).
• When the sick fund of which the patient is a member does not have services in the area of his home that meet his needs.
• For the most part, inpatient rehabilitation treatment will include the following types of treatment:
  • Treatment by a rehabilitation doctor.
  • Nursing care by a rehabilitation nurse.
  • Physiotherapy treatment.
  • Occupational therapy treatment.
  • Language and communication therapy.
  • Psychological treatment.
  • Care from a social worker.
  • Nutritional counselling.
  • Additional treatment as required.

According to the definitions of the health basket, rehabilitation patient hospitalisation is given for up to 3 months, but the period may be extended in certain cases with the approval of the sick fund committee. During the hospitalisation, the patient is entitled to receive all the treatment that he needs without limitation.

The person who decides on the need and the appropriate framework for rehabilitation is a rehabilitation doctor (or a geriatrician in the case of patients over the age of 65) while the patient is still hospitalised in an acute ward (neurology or internal medicine), but the person who is entrusted with the placement in the appropriate framework, according to the arrangements of the insuring sick fund, is the control team on behalf of the insuring health plan.

• Link to Clalit’s selection arrangements
• Link to Maccabi selection arrangements
• Link to Meuhedet’s selection arrangements
• Link to Leumit’s selection arrangements 

Assessments before choosing a rehabilitation framework

• Location: It is important to take into account the physical proximity of the rehabilitation institution to family and friends. This helps to expand the circle that supports the patient and eases the great burden placed on the supporting family members. Many patients report that the presence of family members is desirable and contributes to their mood and functioning during the rehabilitation period.
• Exploratory visit: You can visit and form an impression of the institutions offered, before hospitalisation. Go to the “Above and Beyond” website  to use a search engine to locate a suitable rehabilitation hospitalisation framework.
• Appeal: It is permissible to appeal the decision of the sick fund. It is worth knowing that the appeal may lead to a long waiting time. (For more information, read the page ‘What is rehabilitation.
• According to the Ministry of Health’s directive, if a patient is given a recommendation to for inpatient rehabilitation, he may not be discharged home.

Important things to know:

Prior to release, make sure that you have as many answers as possible that will help you better plan the next stage of rehabilitation.   In any field, it is important that you know what the recommendation for the next framework is. Come to the meetings with pen and paper to write down the answers – sometimes the meetings are emotional and/or loaded with information, and at the end it is difficult to remember everything. Sometimes there will not be answers to all the questions at a specific point in time. In those cases, make yourself a note, in an orderly manner, what needs to be clarified further down the road.

Rehabilitative day hospitalisation

A rehabilitative day hospitalisation framework is intended for patients who require intensive rehabilitation treatment, but do not require full supervision in an inpatient setting, and, from a family and environmental perspective, are able to return home.

A rehabilitative day hospitalisation framework provides the patient with intensive medical-rehabilitative treatment, as decided by the rehabilitation team, between two and five times a week and allows him to receive the necessary treatment while as far as possible maintaining a normal daily routine with maximum independence.

Rehabilitation in a day hospitalisation setting is provided for a person who needs at least three types of treatment from different health professions. Rehabilitation is provided by a multidisciplinary team of therapists (physiotherapy, occupational therapy, speech therapy, social work and rehabilitative psychology) under a uniform rehabilitation programme with the professional guidance of a rehabilitation physician.

A referral for rehabilitative day hospitalisation is possible as a further rehabilitation period after the end of the full hospitalisation rehabilitation period and must be given as an alternative to full hospitalisation. All this is according to the opinion of the professional staff.

The rehabilitation programme and its duration are adapted to the needs of each patient in accordance with the professional diagnosis of the staff that have been treating him. 

Day hospitalisation frameworks sometimes operate as stand-alone facilities as centres, and sometimes in regular hospitalisation frameworks. It is necessary to pay attention to the sick funds’ arrangements with the rehabilitation frameworks, and to provide a payment undertaking (Form 17) from the sick fund if necessary. 

One can go to day hospitalisation in a number of ways or a number of referrals:

• Medical recommendation from a previous inpatient rehabilitation framework.
• Rehabilitative medical counselling that recommends this in the discharge letter from an acute hospitalisation framework.
• Referral from a rehabilitation doctor after evaluation in rehabilitation clinics in hospitals, or in the community after referral from the family doctor.

The Ministry of Health circular states that most patients over the age of 65 after a stroke (who require rehabilitation) must be sent to institutional rehabilitation and not to rehabilitation in the community, even if the recommendation is for non-intensive rehabilitation, if one of the following conditions is met:

• Family, social or environmental conditions will make it difficult to stay at home.
• The required services of the sick fund are not in an area accessible to the patient.

Further important things about preparing for returning home after inpatient rehabilitation can be read here

If necessary, you can ask for help from people in the community:

• Sick fund social worker – for assistance with medication, emotional support and organization at home and in the community.
• Welfare social worker – the welfare services in the community have various options for assistance such as: volunteer service for the patient or to help his children, hot meals, assistance in shopping, social clubs and more.

Rehabilitation in the Community: Centres

After the stage of rehabilitation in full hospitalisation or in day hospitalisation, patients are entitled to continue receiving the rehabilitation treatment that they need in the insuring sick funds in the community.

The use of centres is very important for “completing the rehabilitation process within the community, when it comes to the need for only a few individual areas without the need for multi-professional treatment (e.g. physiotherapy only, speech therapy, and less frequent treatments)”.

After the end of the acute rehabilitation process, when the patient is in the “chronic” stage, a relatively static stage of progress in rehabilitation, and after the end of the periods of intensive rehabilitation that were recommended after the stroke, the number of treatments to which he is entitled each year is limited, according to the health basket. These rehabilitation treatments are provided under the National Health Law by the insuring sick fund, and the number of approved treatments per year usually ranges from 12-24, depending on the health plan and the type of rehabilitation. This rehabilitation can be obtained through a recommendation from the rehabilitation doctor in another rehabilitation framework or through the family doctor.

This rehabilitation can be obtained with a recommendation, in one of the following cases:

1. After discharge from hospitalisation to the patient’s home when there is no need for inpatient rehabilitation or day rehabilitation.
2. After inpatient rehabilitation (which is not defined as continued rehabilitation in rehabilitative day hospitalisation).
3. After a day hospitalisation when it was defined as necessary to continue the on-going treatment.
4. Depending on the needs of the patient, in the community, even if he was not hospitalised at all, even in the chronic stage.

The sick funds usually provide the treatments within the local branch or through the purchase of services from private centres in the community. Sometimes this rehabilitation can also be obtained in hospital centres and clinics, dependent upon a Form 17 from the sick fund.

Rehabilitation in the Community: Rehabilitation Clinic

Rehabilitation clinics exist in rehabilitative hospitals, general hospitals, which have rehabilitation departments, and also in the community. In rehabilitation departments that specialise in the field of rehabilitation after a stroke, there are also rehabilitation clinics that treat only patients after a stroke.

One can go to the rehabilitation clinic with a referral from a family doctor at any stage of the rehabilitation process in cases where there is a problem related to the patient’s functional condition.

The rehabilitation clinic is run by a specialist rehabilitation doctor, who receives patients alone, or with the participation of health care professionals.

Goals of a rehabilitation doctor in a rehabilitation clinic:

• Assessment of the patient’s medical and functional condition based on relevant documents, an examination of the patient and talking to accompanying family members.
• Building a rehabilitation plan that is optimal for the case in relation to the patient’s condition, the rehabilitation options available to him and the functional goals that can be achieved during treatment.
• The rehabilitation programme will include recommendations for further medical treatment, further rehabilitative treatment, including recommended relevant frameworks inside and outside the health system, recommendations for adapting a healthy and active lifestyle, including self-practice, leisure, sporting activities, working and other relevant aspects.
• Instructing the patient and his family on his current condition, the rehabilitation potential at this stage and the proposed rehabilitation programme.
• Writing a summary of the visit, including defining the patient’s medical and functional condition from a rehabilitative point of view and a follow-up treatment plan. The summary, with recommendations, will be forwarded to the patient and his handling doctor.

Rehabilitation in the Community: Home Rehabilitation

In some cases, it is possible to receive rehabilitation in the community in the home of the person being rehabilitated.

Most sick funds approve home rehabilitation as a rehabilitation alternative for relatively light patients who cannot leave the house, and not as further treatment.

Rehabilitation in the patient’s home provides a solution for patients who would normally come to clinics and rehabilitation centres in the community. The advantages of home rehabilitation are convenience for the patient who does not need to make many trips to the rehabilitation centre; he is in his natural environment and thus a connection is made with rehabilitation objectives in the patient’s home. Another benefit is in reducing the risk of exposure to infections.

Before deciding on rehabilitation at home, it is important to take into account considerations such as access to services in the community, the availability of support at home, accessibility at home, etc.

The home rehabilitation plan should include:

1. Determination of a rehabilitation plan by a specially trained medical team.
2. Rehabilitative treatment within the framework of the rehabilitation programme provided by a multi-disciplinary rehabilitation team that includes rehabilitative and nursing medical treatment, as well as the health professions – social work, psychology, physiotherapy, occupational therapy, speech and oral therapy and nutrition counselling.
3. An individual rehabilitation plan will be determined according to the following outline:
   • A multidisciplinary medical and functional evaluation will be performed for each patient at the beginning of the treatment, from which the appropriate rehabilitation programme will be derived. Repeated rehabilitation assessments will be carried out at least once every two weeks . The medical team in charge of the case will determine when the rehabilitation will be completed, and will also decide about further treatment and follow-up.
   • The professional rehabilitation programmes will be adapted by health care providers as needed, in coordination with the medical staff.
   • A doctor from the team will visit the patient’s home once every two weeks, the nursing staff will visit once a week.
   • The treatment from the health professionals will be performed at a frequency of at least five sessions per week, on at least three days per week.
   • An appointed person will be on call and available by telephone for the patient during the sick fund’s operating hours.
   • If the rehabilitation comes after hospitalisation, it will begin no more than 72 hours after discharge from the hospital.
   • The rehabilitation treatment will be documented in the patient’s computerised medical record.

Furthermore, each sick fund operates a home care unit that provides rehabilitation and nursing care for those in need, in their homes. The definition of housebound people can be found here.

This service is operated under the sick fund’s nursing management, which you can contact to receive the service. This service includes a doctor, nurse, occupational therapist, physiotherapist, speech therapist and social worker.

As a rule, the health plan is not allowed to change a recommendation for rehabilitation in full or day hospitalisation, into rehabilitation in the patient’s home, even if the rehabilitation is intense. In addition, a recommendation for full or day rehabilitation cannot be converted into home rehabilitation, on the grounds of lack of beds in the immediate geographic environment or that there is no therapist available in the relevant field of rehabilitation.

If, nevertheless, the sick fund has converted the rehabilitation on these grounds, it is possible to:

1. Contact the director of the relevant rehabilitation department in the district.

2. Contact the Ombudsman at the sick fund.

3. Submit an appeal to the Ministry of Health.

1. • For information and links to complaints regarding non-provision of rehabilitation, please read the Right to Rehabilitation page.