Scope of Program

MMC’s Inpatient Rehabilitation Facility provides the most effective, patient-centered, state-of-the-art rehabilitative care. Our IRF provides comprehensive services that prevent secondary complications, minimize impairment, reduce activity limitations, and maximize participation and quality of life for patients with various diagnoses. Intensive, interdisciplinary rehabilitation, provided by a trained and experienced team, maximizes recovery from the physical, visual, cognitive, and psychological impairments. The multidisciplinary team works collaboratively with the individual and the family and/or caregiver, providing patient-centered care and using evidence-based practices to help every patient achieve his/her full potential.

Mission Statement

The Department of Rehabilitation Medicine at MMC provides comprehensive inpatient and outpatient rehabilitation to individuals with physical disabilities. Rehabilitation Medicine seeks to optimize the capacities of patients whose physical functions are impaired through disease, injury, or congenital malformation. Delivery of care is based upon a multidisciplinary team approach, and services are designed to meet the physical, emotional, and psycho-social needs of patients and their families to restore optimal functional ability to enable individuals to ultimately return home to families, jobs, and their community. Care is provided within a cost-efficient system of treatment and follow-up; this system is monitored and periodically reviewed to permit analysis or trend assessment of outcomes.

Vision Statement

The vision of the Department of Rehabilitation Medicine is to have a major role in meeting the needs of persons with physical disability in the Bronx, the metropolitan New York region and the lower Hudson Valley. The Department of Rehabilitation Medicine also seeks to be a leader in rehabilitation education and to be recognized for significant research contributions to the field of physical medicine and rehabilitation while demonstrating leadership through advocacy for Physiatry and the disabled population at the New York state level. The Department seeks to enhance economic development through optimal staff performance and to provide health care service, which exceeds the expectations of patients and their families.

Scope of Services

The Rehabilitation Program provides comprehensive services and medical management, anchored by interdisciplinary professionals who involve patients and families in all phases of rehabilitative care. The intention of the program is to maximize one’s functional independence by acknowledging the patient’s physical and/or psychological impairments resulting from their diagnosis and/or comorbidities through functional retraining while focusing on the individual’s capabilities. This includes training in compensatory strategies and use of devices. Our team assesses each person’s abilities and helps each patient develop realistic short- and long-term goals, applying the latest research and technology methods. The program provides ongoing access to information about available services and resources that improve the quality of life of the patient.

We can accommodate patients 18 years and older. Unit is open 24 hrs a day 365 days a year. Major diagnostic groups include stroke, brain injury, post-operative or post-fracture orthopedics cases, post-operative spinal surgery, post-op open heart surgery, VAD, general medical/surgical cases, post-revascularization, amputation, transplantation of liver, kidney, heart, or lung, neurologic conditions such as multiple sclerosis, Parkinson, or polyneuropathies such as Guillain-Barre, and oncologic conditions.

The rehabilitation team consists of the patient, his or her family and/or caregivers, and medical, nursing and other rehabilitation personnel who, by virtue of their education and experience, are trained to work with individuals who have rehab needs. Team members include but are not limited to, attending physicians, medical residents, nurses, social workers, case managers, physical therapists, occupational therapists, speech language pathologists, dieticians, respiratory therapists, neuropsychologists, and other medical personnel specializing in certain areas of medicine. The medical and rehabilitation professionals on the team are responsible for assessing the individual’s medical, behavioral, psychological, and rehabilitation needs, establishing individualized goals in consultation with the individual and/or family/caregiver, designing and implementing a treatment program, assessing its outcome, communicating with the team, and preparing the individual and family for the next phase in the rehabilitation process. Cultural and religious needs are respected for each patient by the entire team. Accommodations to the patient’s schedule, dietary needs and requests, and the provision of appropriate equipment are provided to enhance the patient’s experience and support full participation in the rehabilitation program. All staff members participate in annual cultural diversity and sensitivity training. All patient’s personal preferences are identified and communicated to the entire team through shared flowsheet rows in our electronic medical record system to ensure that individualized care is provided.

The discharge planning process begins when the patient is first admitted to the program. The primary goal is to discharge patients back to the community when appropriate. For patients who are not yet ready to return to the community, discharge planning ensures that they can continue the next stage of their rehabilitation at an appropriate facility. After returning to the community, patients are scheduled for physiatry and therapy in our outpatient practices and/or with homecare services.

The rehabilitation potential for every patient is evaluated prior to admission. Every patient must demonstrate a reasonable expectation of measurable improvement that will be of practical value to the patient within a predictable and reasonable period. The patient must require and receive at least three hours a day of physical and/or occupational therapy (or other skilled modalities, including speech-language pathology, prosthetic, or orthotic services) at least five days per week. (The patient must require at least two therapy modalities each day.) We are able to accept patients who require hemodialysis, ongoing chemotherapy, and ventilator assistance, and who require closer monitoring from their medical/surgical team and any specialty department that can be consulted throughout the patient’s stay. Our IRF can assess and treat medical conditions, including wounds (surgical or pressure related), cardiac, endocrine, musculoskeletal, psychological and/or pain diagnoses/comorbidities.

Our IRF is located at the Wakefield Division of Montefiore Medical Center. The patient rooms are located on our 4 East Unit on the 4th floor. Our Speech Language Pathology treatment rooms are located on 4E, and our Occupational Therapy and Physical Therapy treatment gym is located on the 1st floor in the Rehabilitation Medicine Department. Patients may receive care at bedside or in the designated therapy locations. Therapy is provided 7 days per week as per CMS guidelines (3 hours of therapy 5 days per week and supplemented on the 6th and 7th day. Therapists document progress notes following every treatment session. Physician and Nursing care is provided 24 hours per day 7-days per week. Physicians document patient progress 6 of 7 days per week and nursing periodically throughout the shift. Other team members provide care as per the consult request and physician order. Therapy services are scheduled between the hours of 7:30 AM-6 PM.

Payers and funding sources are generally the insurance companies Montefiore is contracted with. A full list of these insurances can be found at the following website: Information for Patients - Insurance Plans Accepted - Montefiore Medical Center. These include but are not limited to commercial/private insurance, no-fault, workman’s compensation, HMOs, and self-insured. Prior authorization, including co-pays, deductibles, or any other financial dues, is determined prior to admission. Persons served and caregivers are made aware of any financial obligation as part of the admission process. Montefiore Medical Center offers financial services for persons served to help assist with any financial barriers when obtaining medical care. Our Financial Services Offices can be found at the following locations:

Referral sources include any provider that identifies the need for IRF. Referrals are routed through Care Port which is a web-based application allowing secure transmittal of patient information from external or internal sources (may include out-of-state or other health systems), via email, fax, or phone.

To schedule an appointment, please call us at 833-REHAB-01 (833-734-2201).

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