After the ICU, Some Older Adults Less Likely to Receive Home-Based Rehabilitation

Home is often where recovery begins after being hospitalized for a serious illness. But for some people, it may also be where gaps in care arise. In a recent study, Yale School of Medicine’s Snigdha Jain, MD, MHS, and colleagues found that social factors, such as income and education, can be associated with whether an older adult receives home-based rehabilitation services after an intensive care unit (ICU) stay. The findings were published in Annals of the American Thoracic Society.

In the ICU, survival is the immediate goal, explains Jain, an assistant professor in the Section of Pulmonary, Critical Care and Sleep Medicine (Yale-PCCSM). But what happens after leaving the hospital is also important, she says. Rehabilitation can shape long-term recovery, independence, and quality of life.

Many patients who leave the ICU face lasting effects such as muscle weakness and cognitive decline. The challenge, Jain says, is not just getting patients through critical illness but also helping them return to the lives they had before.

Jain’s early work found that older adults with lower incomes experienced greater declines in function and cognition after an ICU stay. That discovery led to a deeper question: Where do these gaps in care begin?

Her recent study suggests the answer lies in the care patients receive after they leave the hospital. By linking national survey data with Medicare claims, Jain and her colleagues examined rehabilitation across three settings: skilled nursing facilities, outpatient centers, and home health care. They found that patients who reported limited financial resources, non-white race or Hispanic ethnicity, and lower level of education were associated with reduced probability of receiving post-hospitalization rehabilitation at home, even when their clinical needs were similar.

Lauren Ferrante, MD, MHS, Yale-PCCSM associate professor of medicine and the study’s senior author, says these gaps have broader implications for recovery. “Home health rehabilitation is essential to delivering skilled rehabilitation to the most vulnerable older ICU survivors—those who are homebound,” she says. “Our study identifies gaps in access to home health rehabilitation that, by extension, may be propagating differences in functional recovery after critical illness.”

Why these gaps persist remains an open question, Jain says. “We can’t fully tell where the breakdown is happening—whether clinicians aren’t consistently referring patients to rehabilitation in the first place, or whether patients face barriers that prevent them from receiving that care after a referral is made,” she says.

The work has received broad recognition. The study was named a finalist for the 2025 Yale Office of Health Equity Research Awards for Research Excellence. It is also part of a larger body of work supported by a National Institute on Aging GEMSSTAR award, through which Jain has examined rehabilitation across the full trajectory of critical illness.

Jain’s research is now focused on identifying where intervention is possible—and how to build it into routine care. “Something as simple as whether a patient is evaluated by a physical therapist during hospitalization can determine how everything downstream is affected,” she says. 

Ultimately, Jain sees standardizing the care of critically ill older adults as a key solution. “By building more consistent pathways, we can positively impact the most vulnerable populations,” she says. “As more patients survive critical illness, we need to not only think about who survives—but who recovers, and how.”

Pulmonary, Critical Care and Sleep Medicine is one of 10 sections in the Yale Department of Internal Medicine. To learn more about Yale-PCCSM, visit PCCSM's website or follow them on Facebook and Twitter.