The right to medical rehabilitation is enshrined in the National Health Insurance Law (5754-1994), and the medical services basket includes institutional neurological rehabilitation for stroke victims [link to the law (Hebrew)].
Any individual whose functional autonomy and quality of life have been impaired as a result of an illness or a stroke is eligible for rehabilitation to help minimize the impact.
The rehabilitation process may take place in either an inpatient environment or outside of it according, to the patient’s needs as determined by the rehabilitation doctor. You should begin preparing to return home while still in the rehabilitation process (link in Hebrew).
No two strokes are alike. The neurological damage and subsequent loss of function may vary greatly from one person to the next. The rehabilitation process, treatment plan and its duration will also vary accordingly.
Rehabilitation is a systemic therapeutic process provided within the framework of a holistic program. It is overseen by a rehabilitation specialist working with a multidisciplinary team, that can include physiotherapists, occupational and speech therapists, rehabilitative psychologists, social workers and nurses.
The patient will see the greatest improvement from the rehabilitation process in the months immediately after the cerebrovascular event. During this period, the body and its mechanisms facilitate spontaneous recovery, which is triggered and enhanced by active rehabilitation processes. However, the functional recovery process can continue for many years after the stroke, long after the individual completes his/her inpatient rehabilitation and throughout their subsequent life. This is the result of a constant search for better, alternative methods of overcoming the disability.
Important note: Even after the rehabilitation process is complete and the patient has returned home, they may contact their family doctor at any time if they experience a decline in functional autonomy. The family doctor will be able to issue a referral to a rehabilitation clinic in the community for an evaluation. If necessary, a personalized rehabilitation program will then be provided.
The rehabilitation process is also intended to minimize the risk of immediate and later complications, and to teach the patient and their family how to adjust to life following the cerebrovascular event and how to make the best possible use of the functions that have not been damaged.
The Rehabilitation Process
- Before being discharged from hospital, the patient will undergo a function evaluation to determine whether the next stage of their treatment will be in rehabilitation or in a nursing ward. Should the medical team recommend continued rehabilitation, they will prepare a personalized program for the patient, with a recommendation whether the next stage of rehabilitation should take place in hospital, the community or at home.
You can read more in the following links about each of the options, including eligibility conditions for each :
The function evaluation must be performed by a rehabilitation doctor, or geriatrician in the case of patients over 65, in consultation with a professional social worker or allied health professional (speech therapist, physiotherapist, etc.), before the patient can be discharged. It is very important not to allow the evaluation to be carried out by a neurologist or internal medicine specialist, as they are not experts in rehabilitation and do not necessarily possess the relevant expertise to provide accurate recommendations.
The recommendations in the functional assessment are binding on the insurer (the health maintenance organization), which must approve the rehabilitation recommendation and is not obligated to approve or provide any service not explicitly set out in it. The recommendations must therefore be clear, detailed and unambiguous.
- Alongside the rehabilitation recommendations, the hospital is also obligated to assist the patient in accessing their medical and economic rights with the National Insurance Institute and other service providers. It is the hospital’s duty to inform the patient and their family of their rights regarding treatment, rehabilitation and preparing to be discharged from hospital, including details of any rehabilitation for which the patient may be eligible.
- With the transition to the rehabilitation framework, a multidisciplinary team will begin to implement the program, based on the types of treatments prescribed and the time allotted for rehabilitation.
- During rehabilitation, the patient will receive counselling and support to facilitate their return home and to the community.
- In preparation for the discharge from rehabilitation, the patient will receive a final assessment of their functioning. This is intended to determine their ability to adapt to the home environment. The evaluation will be used to provide recommendations on adapting the home to the patient’s needs based on their functional autonomy.
- Following the initial rehabilitation in hospital, the patient usually completes the process in outpatient hospitalisation or rehabilitation clinics. The duration of this part of the process is defined as three months in the medical services basket and aligns with an individual rehabilitation program.
- After completing the rehabilitation process, the patients` definition changes and become termed “chronically ill”. As a chronically ill patient, they are entitled to a treatment program to maintain their rehabilitation pathway. The program is provided for in the community health plan and includes a limited number of speech therapy, occupational therapy and physiotherapy sessions per year.
Important note: You should be keeping a file with all the recommendations you receive throughout the recovery and rehabilitation processes, as well as treatment and rehabilitation summaries. These important documents will lay the foundations for future decisions. We strongly recommend keeping an orderly file of all medical materials.
At the end of the rehabilitation process, the patient will receive a summary that includes:
· Medical condition — diagnoses, treatments and recommendations for preventive care
· Functional status score – a multidisciplinary assessment of e.g. cognitive and motor functions.
· Recommendations for continued rehabilitation in the community.
· After a period of six months, the family doctor will reevaluate the patient’s functional autonomy in consultation with the rehabilitation team.
Click here for the Ministry of Health director general’s directive “Standards for the Provision of Rehabilitative Care for the Elderly”.
Pursuant to section 7.6 of the directive, the priority for elderly people following a non-minor stroke should be institutional rehabilitation.
Appealing the decision of the insurer (health maintenance organization) regarding rehabilitation?
Complaints may be submitted to the Ministry of Health ombudsman.
In cases where the health maintenance organization (HMO) does not approve or implement the recommended rehabilitation program, or if you have not received a detailed functional evaluation and there is a difference of opinion with the HMO regarding the necessary rehabilitation, you may contact the ombudsman of the specific HMO using the following links:
If necessary, you may also submit a complaint to the Ministry of Health Ombudsman.
For further details on the conditions for filing an appeal, see the Ministry of Health’s website. You may also submit the claim online here.
You can also consult with the Neeman Stroke Survivors` Society (click here) or with the Association for Patients’ Rights (click here). They should also be copied into the referral letters.
You can read more on medical malpractice and filing a complaint here.
Important information:
- A shortage of rehabilitation beds throughout the country (and especially in the periphery) sometimes leads HMOs to discharge stroke patients to their homes and to the community before they have fully exhausted the potential of the rehabilitation process. If the family believes that the patient’s rehabilitation process should be continued, it can provide a second opinion from a rehabilitation specialist and appeal the decision.
- The hospital’s social services must instruct the family on how to prepare the home and the patient’s care in a timely manner before the patient is discharged. Should the patient require an additional period of rest, we advise requesting an extension of the hospitalization.
- Should the patient require a foreign caregiver, submit the permit application as soon as possible. Do not wait until the patient has been discharged. It is better to prepare the forms and submit the application prematurely rather than too late, so as not to delay the return home.
#Sometimes private insurance policies will offer reimbursements for rehabilitative treatment, so if the patient holds a policy of this kind, it is important to check their eligibility.
