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Transition to home is an active part of a patient's program even when they are still in the hospital. Case Managers talk to the patient and family about care needs after discharge. They provide guidance in finding the resources that will help the patient manage rehabilitation care at home.

Patients remain in the facility as long as they need to reach their achievable goals. Some patients remain a few days others may stay for an extended period of time. Early discharge and continuity of care are assured through a planned transition to home-based or outpatient rehabilitation services.