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Transitional Rehabilitation Program

What is a transitional rehabilitation program?

For a patient who has been hospitalized for surgery or a serious illness, the end of the initial hospital stay brings an important question: What can I do to maximize my chances for the best recovery outcome possible? Often patients, with the support of family, can begin their recovery from home with outpatient rehabilitation therapy at a local hospital or through a home health agency. However, some patients need additional care that requires intensive supervision and rehabilitation care. For these patients, Atmore Community Hospital's Transitional Rehabilitation program is an option.

Qualified patients are admitted to the transitional rehabilitation program by a local physician selected by the patient. Under a physician's direction, a multi-disciplinary team comprised of nursing, physical/occupational/speech therapy, pharmacy, nutrition and social services professionals develop a care plan tailored to the needs of each patient.

What services do patients receive?

Patients admitted to the transitional rehabilitation program will receive around-the-clock nursing care. Depending on the patient's specific needs, other services may include:

Physical therapy

Occupational therapy

Speech therapy

Respiratory therapy

Pharmacy/IV therapy

Wound therapy

Nutritional management and education

How long do patients stay in the program?

Most patients stay in the transitional rehabilitation program ten to fifteen days before returning home. In some cases, patients who can no longer live safely at home may transfer to an assisted living or long-term care facility, depending on their and their family's choice.

Will insurance pay for the program?

Patients covered by Medicare and most Medicare Advantage plans may qualify to stay in the transitional rehabilitation program up to 100 days, if medically necessary, with Medicare paying 100 percent of the cost the first twenty days. Some other insurance plans may provide coverage for inpatient skilled care.

Why Choose Atmore Community Hospital's Transitional Rehabilitation program?

24/7 nursing care from experienced registered nurses and other nursing staff

Interdisciplinary team approach to determine each patient's skilled needs, develop a customized plan of care and establish realistic discharge goals

Proactive case management/discharge planning

In-house physical, occupational, speech and respiratory therapy by licensed,

experienced therapists.

In-house laboratory, pharmacy, imaging and nutritional services

Primary physician rounds as needed based on skilled needs

Emergency Department physician on duty 24/7 if needed


In order to qualify for Atmore Community Hospital's Transitional Rehabilitation program, a patient must meet the following requirements:

Have had an acute hospital stay of at least three (3) days just prior to admission;

Have a diagnosis and needs that meet the criteria for inpatient skilled care as

defined by Medicare and;

Are covered under Medicare Part "A" or have coverage for inpatient skilled care

under another medical insurance plan


If you or a member of your family have questions and would like more information about Atmore Community Hospital's Transitional Rehabilitation program, please contact Morgan Marsh, R.N. at 251-368-6345.

Atmore Community Hospital
401 Medical Park Drive
Atmore, AL 36502
(251) 368-2500