"What determines where the survivor goes? Post acute or acute? You already have that information in your evaluation section --- levels 1-4 go to post acute; 4 and up go to acute. However, it is important to know that if the patient does manage to get evaluated for acute, it doesn't mean they will stay there! If they don't make enough progress quickly enough they will end up in the post acute facility -- or, as I advocate, they should go home and do outpatient therapies." ~ Martha

This is a very individual determination, based on many factors:

• The extent of the injury,
• The level and rate of recovery,
• The need for continuing care,
• Availability of services,
• Financial considerations,
• The extent to which you are willing to advocate for care.

Patients will be evaluated by the medical team, and also by the facility to which they may be transferring to.

You may be asked to make decisions which may seem very overwhelming. Take notes, record meetings, take time and review options. Ask lots of questions. You may wish to make a decision based on many factors; the reputation of the facility, the location of the facility, the types of services offered, the goals of the facility, the special needs of the patient. Your decision may be limited by financial factors.

Keep in mind that once the patient begins to emerge you may wish to be involved on a regular basis with physical, occupational or speech therapies, so location may be important.

Typically, the patient, upon leaving the ICU, will be transferred to the hospital's neuro unit, then to a rehab facility. Sometimes the patient may be transferred to a nursing facility on an interim basis if he/she has not achieved a level of responsivity which would allow him/her to benefit from a rehabiltation facility or a coma recovery program. From there, depending on the patient, they will either be evaluated for care in another facility or returned home. None of these transfers are totally dependent on the patient being fully "awake and alert".