Advocating for Equity: Bridging the Gap in Inpatient Rehabilitation Access

A new study published in Neurology^® Open Access, led by Farhaan S. Vahidy, PhD, MBBS, chief scientific officer at TIRR Memorial Hermann, shines a critical light on the inconsistent and often inequitable landscape of access to care at inpatient rehabilitation facilities (IRFs). The findings reveal significant barriers to recovery for brain injury and stroke patients, with fewer than one in four stroke survivors and fewer than one in seven traumatic brain injury survivors being discharged to inpatient rehabilitation facilities.

“Receiving intensive rehabilitation after stroke, traumatic brain injury and spinal cord injury can improve a person’s recovery, yet access to inpatient rehabilitation care remains inconsistent and may not be equitable,” said Dr. Vahidy.

The analysis of 444,908 people in five states with stroke, traumatic brain injury and spinal cord injury found:

• 22% were sent to inpatient rehabilitation
• 26% went to skilled nursing facilities
• 54% were discharged home

After adjusting for factors such as insurance, a person’s home residence and health factors like high blood pressure and diabetes, researchers found the following differences in being discharged to an inpatient rehabilitation facility versus discharged to home:

• Older people (average age of 75) had a 4% higher rate than younger people (average age of 63)
• Female participants had a 19% higher rate than male participants
• Black people had a 29% higher rate than white people
• Hispanic people had a 22% lower rate compared to white individuals

Beyond the overall low admission rates for inpatient rehabilitation care, the study uncovered stark disparities in access based on sex, race, insurance coverage and income level. Furthermore, systemic barriers tied to insurance types and neighborhood income levels further dictate who receives this intensive level of care. To improve long term outcomes and establish more consistent care, the authors advocate for more equitable access to inpatient rehabilitation and call for future research specifically designed to identify and eliminate these systemic disparities.

These findings serve as a powerful reminder that clinical excellence alone is not enough. At TIRR Memorial Hermann, this research directly fuels our enduring commitment to patient advocacy and equitable health care delivery. Because many individuals face systemic barriers that prevent them from ever reaching our facilities, we recognize a deep responsibility to provide care, education and support beyond our hospital boundaries through research, advocacy and strong inclusive community programs.

Our vision is to change lives by redefining rehabilitation, championing inclusion and offering hope to all who need our care.