Scope of Services

Montefiore Einstein’s inpatient rehabilitation facility (IRF) provides the most effective, patient-centered, state-of-the-art rehabilitative care. Our IRF delivers 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 is provided by a trained and experienced team that maximizes recovery from physical, visual, cognitive and psychological impairments. Our multidisciplinary team works collaboratively with the individual, family and/or caregiver, providing patient-centered care and using evidence-based practices to help every patient achieve their full potential.

The Department of Physical Medicine and Rehabilitation at Montefiore Einstein provides comprehensive inpatient and outpatient rehabilitation to individuals with physical disabilities. Rehabilitation medicine aims to optimize the capacities of patients whose physical functions are impaired due to 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 psychosocial needs of patients and their families to restore optimal functional ability and enable individuals to ultimately return home to their families, jobs and 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.

The Department of Physical Medicine and Rehabilitation’s vision is to play a major role in meeting the needs of individuals with physical disabilities in the Bronx, the New York Metropolitan Area and the lower Hudson Valley. The Department seeks to enhance economic development through optimal staff performance and to provide healthcare services that exceed the expectations of patients and their families.

The Rehabilitation Program at Montefiore Einstein provides comprehensive services and medical management, anchored by interdisciplinary professionals who involve patients and families in all phases of rehabilitative care. The Program intends to maximize a patient’s functional independence by acknowledging the 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 the use of devices. Our team assesses each person’s abilities and helps patients 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 patient’s quality of life.

We can accommodate patients 18 years and older. The unit is open 24 hours a day, 365 days a year. Major diagnostic groups include stroke, brain injury, postoperative or post-fracture orthopedics cases, postoperative spinal surgery, postoperative open heart surgery, ventricular assist device (VAD), general medical/surgical cases, post-revascularization, amputation, transplantation of liver, kidney, heart or lung, neurologic conditions such as multiple sclerosis, Parkinson’s disease or polyneuropathies such as Guillain-Barré syndrome, and oncologic conditions.

The rehabilitation team consists of the patient, their 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 with rehabilitation 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, dietitians, 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. Accommodations to the patient’s schedule, dietary needs and requests and appropriate equipment are provided to enhance the patient’s experience and support full participation in the rehabilitation program. To ensure individualized care, all patients’ preferences are identified and communicated to the entire team through shared flow sheet rows in our electronic medical record system.

Discharge planning 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 home care services.

The rehabilitation potential for every patient is evaluated before admission. Every patient must demonstrate a reasonable expectation of measurable improvement that will be of practical value to them 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 can accept patients who require hemodialysis, ongoing chemotherapy and ventilator assistance, as well as patients who need closer monitoring from their medical or 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 or comorbidities.

Our IRF is located at the Wakefield Campus of Montefiore Einstein. The patient rooms are located on our 4 East Unit on the fourth floor. Our speech-language pathology treatment rooms are on 4E, and our occupational therapy and physical therapy treatment gym is on the first floor in the Department of Physical Medicine and Rehabilitation. Patients may receive care at bedside or in the designated therapy locations. Per Centers for Medicare & Medicaid Services (CMS) guidelines, therapy is provided seven days per week (three hours of treatment, five days per week and supplemented on the sixth and seventh days). Therapists update progress notes following every treatment session. Physician and nursing care is provided 24 hours a day, seven days a week. Physicians document patient progress six to seven days weekly, and nurses 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 and 6:00 pm.

Payers and funding sources are generally the insurance companies Montefiore Einstein is contracted with. A complete list of these insurance plans can be found at the following webpage: Information for Patients: Insurance Plans Accepted | Montefiore Einstein. These include but are not limited to commercial/private insurance, no-fault, workman’s compensation, health maintenance organization (HMOs) and self-insured. Prior authorization, including copays, deductibles or other financial dues, is determined before admission. Persons served and caregivers are made aware of any financial obligation as part of the admission process. Montefiore Einstein offers financial services to help individuals with financial barriers when accessing medical care. 

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