The most appropriate management of this patient is short-term rehabilitation at a skilled nursing facility (SNF). The purpose of rehabilitation is to maximize functional recovery and independence. Older patients such as this one often require posthospital rehabilitation due to deconditioning associated with acute medical or surgical illness. Rehabilitation can be provided in many different settings, and the optimal type and location of rehabilitation depends on the medical needs of the patient and his or her ability to participate in rehabilitation activities. This patient requires the assistance of another person for safety in accomplishing basic activities of daily living, such as transfers and toileting, and although her family is supportive, they would not be able to provide the level of care needed. Additionally, this patient is actively participating in therapy and making progress; however, she is unable to tolerate intensive rehabilitation services (usually defined as 3 hours per day, 5 days per week) at this time. For these reasons, this patient would be better suited to lower-intensity rehabilitation at a SNF, most of which are able to provide these services.

Rehabilitation services can be provided on an outpatient basis, either in the patient's own home if the patient is homebound or at an outpatient rehabilitation clinic in patients who are more functional. However, because this patient's family is not able to provide adequately extensive care in the home, rehabilitation services in this setting are not appropriate.

Long-term acute care hospitals (LTACHs) are designed to accommodate complex, high-intensity care needs for patients who require frequent physician input but no longer require standard hospitalization. Patients who require care at an LTACH include those with ongoing mechanical ventilation weaning, complex wound care needs, or multiple intravenous therapies. Although LTACHs may provide rehabilitation services, this is not their primary function. This patient does not require the level of medical care provided in an LTACH, and the focus of her care should be on rehabilitation.

Free-standing rehabilitation hospitals or units provide specialized, high-intensity rehabilitation under the direction of physiatrists. They have specific admission criteria, one of which is usually the ability to participate in 3 hours of therapy per day during the week, which this patient would not tolerate.