Fewer people receive intensive rehabilitation than are likely eligible
Only 22% of stroke patients and 14% of TBI patients discharged to inpatient rehabilitation facilities despite evidence intensive care improves recovery outcomes. Disparities favor older, female, and Black patients; private insurance holders and higher-income residents face lower odds of accessing intensive rehabilitation care.
- 22% of stroke patients and 14% of traumatic brain injury patients discharged to inpatient rehabilitation facilities
- Study reviewed 444,908 adults across five states over four years
- Inpatient facilities provide 3+ hours of therapy daily versus less intensive skilled nursing care
- Black patients had 29% higher odds, Hispanic patients 22% lower odds of intensive rehabilitation access
Study reveals fewer than 25% of stroke patients and 14% of traumatic brain injury patients receive intensive inpatient rehabilitation after hospitalization, with significant disparities by race, insurance, and income.
A study released in June 2026 found that most people hospitalized with stroke or traumatic brain injury never receive the intensive rehabilitation that could help them recover. Researchers reviewing four years of health records across five states tracked nearly 445,000 adults—average age 69—who had been admitted for stroke, brain injury, or spinal cord injury. Three-quarters of them had suffered a stroke. When these patients left the hospital, only 22 percent of stroke survivors and 14 percent of those with traumatic brain injury were sent to an inpatient rehabilitation facility, the kind of place where patients receive more than three hours of therapy per day. The rest went to skilled nursing facilities or straight home. For spinal cord injury, the number was higher at 44 percent, but still far below what researchers believe should be the case.
The gap matters because evidence shows intensive rehabilitation improves recovery. Yet access to it remains spotty and unequal. Farhaan Vahidy, the study's lead author and a researcher at TIRR Memorial Hermann in Houston, noted that inpatient rehabilitation facilities offer substantially more intensive care than skilled nursing facilities—a difference that could shape how well someone regains function after a neurological injury. "Our study found fewer people receive this type of rehabilitation than are likely eligible," Vahidy said, "with concerning disparities affecting historically marginalized communities, people with Medicaid and those from lower-income areas."
The disparities cut in unexpected directions. When researchers adjusted for factors like insurance type, where someone lived, and underlying health conditions, they found that older patients—those averaging 75 years old—had 4 percent higher odds than younger patients of being sent to an inpatient facility rather than home. Women had 19 percent higher odds than men. Black patients had 29 percent higher odds than white patients. But Hispanic patients had 22 percent lower odds than white patients. The pattern grew more complex when researchers looked only at people who were discharged to some form of institutional care: among that group, Black patients had 10 percent lower odds of going to an intensive rehabilitation facility instead of a skilled nursing facility.
Insurance status and income also shaped outcomes. People with private insurance or Medicaid had 12 percent lower odds of being sent to inpatient rehabilitation compared to those with Medicare. Living in the highest-income neighborhoods compared to the lowest-income areas was also associated with lower odds of accessing intensive rehabilitation. The findings suggest that wealth and insurance type, rather than uniformly opening doors, sometimes closed them—a counterintuitive result that hints at how complex the discharge process really is.
The researchers acknowledged significant limitations. The data came from administrative records, which cannot reveal why hospitals made the discharge decisions they did. Medical records don't capture social factors—whether someone had family to help at home, whether they lived alone, whether transportation was available—that likely influence where patients end up. The data also lacked information about injury severity, meaning researchers couldn't determine whether sicker patients were more likely to be sent to intensive facilities or whether discharge decisions reflected something else entirely. Still, the broad pattern is clear: hundreds of thousands of people each year who might benefit from intensive rehabilitation are not receiving it, and the gaps fall unevenly across racial, economic, and gender lines. Vahidy called for future research to examine these differences more closely and for healthcare systems to develop interventions that could distribute intensive rehabilitation more fairly and improve long-term outcomes for people recovering from these serious neurological injuries.
Notable Quotes
Access to inpatient rehabilitation care remains inconsistent and may not be equitable, despite evidence that intensive rehabilitation improves recovery.— Farhaan S. Vahidy, TIRR Memorial Hermann
Ensuring equitable access to intensive inpatient rehabilitation can help improve long-term outcomes for people with these conditions.— Farhaan S. Vahidy
The Hearth Conversation Another angle on the story
Why does it matter where someone goes after they leave the hospital? Isn't recovery mostly about time and effort?
Intensive rehabilitation facilities provide more than three hours of therapy daily—physical therapy, occupational therapy, speech therapy. Skilled nursing facilities offer less. The difference compounds over weeks and months. Someone relearning how to walk or speak needs that volume of specialized care to rewire their brain.
So the study is saying most people aren't getting that?
Right. Only one in four stroke patients and one in seven with brain injury. The rest go home or to places with lighter therapy schedules. Many of those people could have benefited from intensive care but didn't receive it.
The disparities seem strange—older people and women and Black patients had *higher* odds of getting intensive care. Isn't that the opposite of what we'd expect?
It is. The researchers adjusted for insurance and health factors, so it's not that these groups were sicker. It might reflect that some hospitals or discharge planners recognize greater need in these populations, or it could reflect other unmeasured factors—family support, living situation, how vocal patients are about their preferences. The data doesn't explain the why.
But people with private insurance had *lower* odds. That's backwards too.
It suggests the system isn't working the way we assume. Maybe private insurance patients are more likely to have family who can help at home, so discharge planners send them there. Or maybe they're younger and perceived as having better recovery potential without intensive facility care. The records don't say. That's the real problem—we see the outcome but not the reasoning.
What happens to the people who go home instead?
That's the question the study can't answer. Some probably do fine. Others might have recovered better with intensive therapy. Without follow-up data on their actual outcomes, we're left with a gap between what the evidence suggests helps and what's actually happening.