this is WHERE john is now ...
🧠 Phase 1 — ICU → Neuro (you’re here)
Milestones just hit:
- Vasospasm resolved
- Brain drain (EVD) removed
- Medically stable enough to leave ICU
What they’re watching now:
- Stable vitals, no new neuro decline
- Swallowing (can he eat safely?)
- Basic participation (follow commands, engage)
next is .....
🚀 Phase 2 — Ready for IRF (the gate)
He moves to IRF when:
- Medically stable (no ICU-level care)
- Can participate in therapy (not perfect, just engaged)
- Needs multiple therapies (PT + OT + speech)
👉 This is the critical placement decision
🏋️ Phase 3 — IRF (intensive rehab)
Goal: regain function fast
Milestones inside IRF:
- Sit → stand → walk (even assisted)
- Use of affected arm/hand improving
- Speech / cognition improving
- Can do basic self-care (toilet, dress, eat)
🧭 Phase 4 — Discharge decision (big fork)
At end of IRF, they choose:
🏠 Option A — Home (best case)
- Safe to move around (maybe with walker)
- Can manage basic needs or has help
- Continue outpatient or home therapy
👉 This is the goal
🏥 Option B — SNF (step-down)
- Not safe at home yet
- Needs more rehab but less intense
👉 Temporary bridge
🧑⚕️ Option C — Long-term care (rare here)
- Only if severe deficits + no recovery trajectory
👉 From your description: unlikely
⚡ Simple flow
ICU → Neuro → IRF → (Home ⬅️ goal) or SNF → Home
🔑 The real decisions
- IRF vs SNF first (you’re fighting this now)
- At IRF discharge: Home vs SNF
- Home support level (alone vs help vs services)
