Synergizing Home Health Rehabilitation Therapy

Patients are eligible if they * are 65 years of age over older * are Medicare beneficiaries * are referred for skilled rehabilitation services at the partnered home health agency * have three or more comorbidities Patients are ineligible if they have * acute fractures with surgical or weight-bearing restrictions, * elective joint replacement surgery * lower-extremity amputation * active treatment for cancer diagnosis * ongoing dialysis treatment * acute cardiac surgery, * acute stroke or a major neurologic disorder limiting motor movements * terminal stage of congestive heart failure * a referral to hospice care * severe cognitive deficits limiting verbal communication.