The three main options are: (1) inpatient rehabilitation facility (IRF) — intensive therapy (three hours per day), appropriate for those with good cognitive and physical endurance; (2) skilled nursing facility (SNF) — lower-intensity therapy and nursing care for those not ready for IRF intensity; and (3) home recovery with outpatient or home health physical therapy — appropriate for highly motivated patients with good functional status and strong home support.

Many younger, healthier hip replacement patients go directly home with outpatient physical therapy. For older adults — especially those who live alone, had low functional status before surgery, have other medical conditions, or live in homes with stairs or barriers — a period of inpatient rehabilitation or SNF care is safer before returning home. The surgeon and hospital discharge planner will typically provide a recommendation.

Inpatient rehabilitation provides intensive daily therapy (physical, occupational, and sometimes speech), 24-hour nursing support, and a structured recovery environment. For hip replacement patients who are motivated and can tolerate the intensity, IRF leads to faster recovery of function and shorter overall recovery times compared to SNF. Medicare covers IRF care when the patient meets the intensity and medical necessity criteria.

SNFs provide physical and occupational therapy at a lower intensity than IRF — typically 45 to 90 minutes per discipline per day rather than three hours total. SNFs are appropriate for patients who need the structure and nursing oversight of a facility but cannot tolerate inpatient rehab intensity. Medicare covers SNF stays following a qualifying three-night hospital admission, with costs applying after day 20.

Most hip replacement patients who go to SNF for rehab are there for 10 to 21 days. Those who recover quickly and have a safe home environment may discharge sooner; those with complications or significant pre-existing functional limitations may stay longer. Medicare coverage can continue up to 100 days as long as skilled care needs remain, but most hip replacement recoveries are well complete before that limit.

Ask: how many hours of therapy per day will my loved one receive? Do you have an orthopedic rehab program or track record with hip replacement patients? What is your nurse-to-patient ratio? Do therapists work weekends? What is your average length of stay for hip replacement patients? Do occupational therapists assess home safety before discharge? What is your readmission rate? These questions reveal whether the facility has a serious rehabilitation program.

Posterior hip replacement requires specific precautions: no bending the hip past 90 degrees, no crossing legs, no turning the foot inward. These precautions are crucial to prevent dislocation in the early healing phase. All staff who assist with mobility, toileting, and transfers must know and apply these precautions. Ask the facility specifically: how do you ensure all staff know and follow hip precautions? Wrong transfers are a leading cause of post-surgical dislocation.

A hip replacement patient returning home typically needs: a raised toilet seat; grab bars in the bathroom; removal of trip hazards (rugs, cords); a shower chair or bench; reachable items to avoid bending; a firm chair with arms for safe standing; and potentially a temporary first-floor bedroom if stairs are a barrier. An occupational therapist can conduct a home safety evaluation and provide specific recommendations.

Outpatient physical therapy involves scheduled clinic visits for progressive exercise, gait training, and strengthening after surgery. It is appropriate for patients who go directly home after surgery or who complete inpatient rehab and return home. Typically three sessions per week for six to twelve weeks, gradually tapering as function improves. Medicare Part B covers outpatient physical therapy subject to the annual therapy cap.

Complications that may extend care needs include: surgical site infection; dislocation of the new joint; deep vein thrombosis (DVT); pulmonary embolism; periprosthetic fracture; delirium (especially in older patients); and pneumonia from reduced mobility. Any of these complications may require hospitalization or extended SNF care beyond the typical hip replacement timeline. A facility with experience managing post-surgical complications is particularly important for high-risk patients.

Older adults undergoing hip replacement have elevated risk of post-operative delirium — acute confusion caused by anesthesia, pain medications, sleep disruption, and the stress of surgery. Delirium significantly delays functional recovery and increases fall risk. Facilities that have delirium prevention and management protocols — early mobilization, orientation support, avoidance of unnecessary medications — produce better recovery outcomes for hip replacement patients.

Standard assisted living generally cannot provide the structured physical therapy program that hip replacement recovery requires. Assisted living may be appropriate AFTER SNF rehab when the patient is largely recovered but still needs help with daily activities during the final recovery phase. Some assisted living communities have therapy services on-site that can continue exercises as a supplement to outpatient therapy — ask specifically what is available.