How Rehab Hospitals Can Ease Acute Care Overload

Summary

Advancing Health Podcast Summary

Episode Title: How Rehab Hospitals Can Ease Acute Care Overload
Date: April 1, 2026
Host: Tom Hiderly, Senior Communications Specialist, American Hospital Association
Guest: Scott Edelman, Executive Director, Burke Rehabilitation

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Episode Overview

This episode explores how rehabilitation hospitals, like Burke Rehabilitation, serve as vital "safety valves" to relieve acute care hospitals straining under rising patient numbers, workforce shortages, and demographic pressures. The discussion highlights innovative strategies, patient-centered care models, and practical advice for healthcare leaders seeking to optimize patient flow and outcomes in a challenging environment.

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Key Discussion Points and Insights

1. The Growing Strain on Acute Care Hospitals

• Acute Demand:
  • “An aging population, nursing shortages, overcrowded emergency departments... all add up to an intense demand on acute care hospitals where inpatient days are projected to rise by 9% in the coming decade.” (Tom Hiderly, 00:00)
• Disconnect:
  • Acute hospitals are challenged to meet rising demands due to resource constraints.
  • Rehabilitation hospitals serve a strategic role in decompressing acute care settings.

2. The Role of Rehabilitation Hospitals as a "Safety Valve"

• Patient Flow:
  • Burke Rehab acts as a “safety valve” by accepting patients post-acute event, thereby freeing beds and reducing ER overcrowding. (Scott Edelman, 01:05)
• Referral Process:
  • Patients typically require a three-day inpatient hospital stay before transfer to inpatient rehab. (Edelman, 02:17)
  • Skilled nursing facilities serve as alternatives for cases outside rehab hospitals’ criteria.

3. Capacity and Workforce Management

• Current Capacity:
  • Burke operates 150 beds and remains below capacity (current census: 142/150).
  • Edelman dispels the myth that all IRFs (Inpatient Rehab Facilities) are always full—emphasizing the importance of sending referrals and letting clinical review determine eligibility. (02:54)
• Workforce Stability:
  • Burke maintains one of the lowest turnover rates (<5%) in its region due to changes in compensation, retirement, and medical plans.
  • Nearly fully staffed with RNs despite regional shortages.

4. Recruitment and Training

• Professional Expansion:
  • Ambitious growth plans: from 15 to potentially 50 outpatient sites.
  • Continuous need for physical, occupational, and speech therapists.
  • Robust physician training with 20 residents, 4 fellows—“We train our physicians to go out and do amazing things.” (Edelman, 03:47)

5. Innovative and Comprehensive Care Models

• Service Expansion:
  • Inpatient dialysis added, allowing acceptance of patients previously ineligible for rehab.
  • Added TPN (Total Parenteral Nutrition) and planning to expand to disorders of consciousness.
  • Outpatient visits exceed 200,000 annually, with 3,300 inpatient cases. (04:54)
• Patient-Centered Focus:
  • “Everything we do is focused on how can we get the patient back to maximum functional recovery.” (07:42)
  • Non-mandated therapies (neurological music therapy, pet therapy) provided to improve recovery experiences.
• Tracking Trends:
  • Increasing neurological diagnoses (e.g., strokes, especially in young people).
  • Shift away from inpatient orthopedics, now mostly managed in skilled nursing or home settings.
  • 90 of 150 beds dedicated to neurologic conditions; average length of stay 14–15 days. (06:05)

6. Maintaining Quality and Continuity

• Patient Follow-Up:
  • Personalized touch, such as “Welcome to the Burke family” cards and ongoing patient contact after discharge.
  • National recognition for quality and workplace excellence.

7. Advice for Health System Leaders

• Actionable Recommendations:
  • Listen closely to acute care partners and focus on reducing length of stay. (08:54)
  • “Don’t be afraid to swing big and fall hard... Not every one [initiative] will be home runs, but hope for some base hits.” (Edelman, 08:54)
  • Leadership through presence—spending daily time on units with patients, families, and staff.

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Notable Quotes & Memorable Moments

• On being a safety valve:

  “We are a safety valve for acute care hospitals and improve the whole patient flow.” (Scott Edelman, 01:05)

• Staffing success:

  “We have one of the lowest turnover, employee turnover rates in the tri state area... We're almost fully staffed with our RNs.” (Edelman, 02:54)

• On service innovation:

  “A year ago, we added inpatient dialysis to our programs here at Burke. Prior to that, if you need an inpatient rehab and you are on active dialysis, you wouldn't be able to admit it.” (Edelman, 04:54)

• On patient focus:

  “Everything we do is focused on how can we get the patient back to maximum functional recovery.” (Edelman, 07:42)

• Advice to peers:

  “Don’t be afraid to swing big and fall hard... leadership is everything. I start and end my day on the patient units, talking to patients and families and employees.” (Edelman, 08:54)

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Timestamps for Key Segments

• Acute hospital pressures & rehab’s safety valve role: 00:47–02:17
• Navigating referrals & capacity: 02:17–03:37
• Recruitment, training, and staffing philosophy: 03:47–04:23
• Innovations in care: dialysis, TPN, complex cases: 04:54–06:05
• Neurological case trends & therapy spectrum: 06:05–07:28
• Patient-centered approach & continuity of care: 07:42–08:37
• Advice for healthcare leaders: 08:54–09:56

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Conclusion

Scott Edelman's conversation with Tom Hiderly provides a candid, in-the-trenches look at how rehab hospitals like Burke are innovating, adapting, and providing relief to the acute care side of the health system. Their formula combines data-driven expansion, workforce investment, and unwavering patient dedication. For healthcare administrators and clinicians alike, this episode is a masterclass in managing capacity, catalyzing workforce resilience, and never losing sight of the patient journey.

Transcript

[A]

Welcome to Advancing Health. An aging population, nursing shortages, overcrowded emergency departments. These all add up to an intense demand on acute care hospitals where inpatient days are projected to rise by 9% in the coming decade. Hi everyone. I'm Tom Hiderly, senior communications specialist with the American Hospital association and very pleased today to welcome Scott Edelman to our podcast. Scott is executive director of Burke Rehabilitation and he joins me today to talk about ways we can alleviate the growing stress on acute care hospitals. Scott, thank you so much for joining me on Advancing Health today.

[B]

Oh, thank you so much. It's a thrill to be here. I listen to every podcast and they all serve a tremendous purpose.

[A]

Maybe we can frame this at the start by talking about acute care hospitals in general in terms of the demand for their resources right now and their ability to meet that demand. Where is the disconnect there? Are there more people that need the services than they really have the capability to deliver on?

[B]

So let's just talk about the strategic role we play. The role we play is decompress acute care hospitals. We are a safety valve for acute care hospitals and improve the whole patient flow. One of the main contributors to the entire system right now is post acute care. Where does someone go after a traumatic event? Burke. We have being 150 bed inpatient hospital. We are seeing a shrinkage of IRF inpatient rehab facility beds in the tri state area because of how busy the hospitals are and they need to create capacity. So we become the safety valve. So it's a critical point that all acute hospitals that we have fantastic relationship with use us, use us as a safety valve. So to remove and reduce the number of people in emergency rooms that are in the hallway waiting for beds. So to answer your question, I feel right now at 150 beds, we have enough beds and when it becomes where we need more, we will petition the state for more.

[A]

So if a patient goes to an acute care hospital and is told we are really crowded, can't deal with you right now, they know to refer that patient to Burke.

[B]

So the rules to the game about being referred to an acute rehab hospital, you have to have a three day inpatient hospital stay. So a patient goes to White Plains Hospital for a traumatic event, a stroke, they're there three to four days stabilized, then they're referred to Burke and then the journey continues. Another valve is a skilled nursing facility because they might be too sick for Burke or not sick enough. But we're here to treat the patients in the right setting at the right time.

[A]

Doesn't Burke deal with some of the same capacity management and workforce challenges that many of the other hospitals do.

[B]

So right now we don't have a capacity issue. Right. So we're 150 bed hospital. Today's census is I think 142. So you know, the myth that Burke is full or IRFs are full. I always tell the acute hospitals, just refer the patient. Let us go through the clinicals, let us go through the insurance approval. Right now, because of the culture at Burke, we have one of the lowest turnover, employee turnover rates in the tri state area. We had made some changes to our compensation philosophy, to our retirement plan, to our medical plan, and we're seeing less than a 5% turnover. And as far as the tri state area that's seeing an RN crisis, we're almost fully staffed with our ends.

[A]

That is really impressive because all we hear about today, of course, is workforce challenges. And it's so hard to recruit and train and keep people. But you really sounds like you're really doing it right.

[B]

Yeah, Tom, on the recruitment side, you know, we're always looking for the best and the brightest. You know, we want to hire a lot more physical and occupational therapists and speech because of our rapid and aggressive expansion plans. You know, we have 15 outpatient sites. I think the number is 50 that we need. But we're going to need a lot more qualified PTO t and speech therapists. We have a great complement of physicians. We have one of the biggest teaching programs in the country. We have 20 residents and four fellows. And we train our physicians to go out and do amazing things.

[A]

Well, let's drill down into that a little bit. The hands on, if I have the number right, I think I read that Burke Rehabilitation receives more than 200,000 patient visits each year in total across all of your facilities. I know you offer both hospital based rehabilitation and an extensive menu that you talked about at the beginning of our conversation. An extensive venue of outpatient therapy programs. What is Burke doing differently in both of those settings to support and treat clinically complex cases more efficiently and more economically?

[B]

Great question. So on the inpatient side, in 2025, we treated 3,300 inpatients. On the outpatient, it was over 200,000. What we're doing differently is making sure that we add the right services and can support those services. And I'll give you an example. A year ago, we added inpatient dialysis to our programs here at Burke. Prior to that, if you need an inpatient rehab and you are on active dialysis, you, you wouldn't be able to admit it. Last year we admitted over 100 patients that needed rehab and on dialysis, we've added TPN, total parental nutrition. We're looking to add disorders of consciousness. We want to make sure that if there's a neurological or traumatic event, the entire country knows that Burke is the right place to get better.

[A]

Well said. And it's just so impressive, the sheer breadth of the different services and therapies that you offer. Which kind of leads me to the next question. What kinds of care or medical procedures seem the most promising in terms of delivering care in new ways that, that do put less stress on acute care hospitals?

[B]

Right. So what we're seeing is neurological diagnosis are on the uptick. We're seeing a lot more strokes, especially in young people, and a lot of hospitals aren't equipped to deal with stage one or trauma one. And what we're doing in our Montefiore health system is making sure from any initial diagnosis that we have everything in the health system from your first admission to your discharge to home for continuum of care and follow up, we're seeing a lot less orthopedic admissions because they're going more to skilled nursing facilities or to home. And as a product of this, Tom, 90 of our 150 beds are focused on neurologic conditions and we might have to expand that more. Of our 150 beds, we do a lot of transplant patients, we do a lot of cardiac, we do pulmonary patients. Our patients average length of stay is 14, 15 days. Once they check into our beautiful 61 acre campus, they really get settled in, understand what recovery is. 3 hours plus hours of therapy per day. We also do ancillary therapy that's not really required of an acute rehab. We do neurological music therapy, we do pet therapy. And this is all to help the patients get better.

[A]

It struck me that maybe one of the secrets to your success so far has been what patient needs are where they're moving. As you pointed out, we're seeing growth in this area, some declines in that area. You're really just sort of tracking what's going on in health generally in this country, isn't it?

[B]

I think you hit the nail on the head, but it all starts with the patient. Everything we do is focused on how can we get the patient back to maximum functional recovery. When we look at a product or service, it doesn't necessarily have to have direct roi, return on investment, but it has to speak to patient quality, patient safety, how do we get patients back home, back to the life they love. And how after discharge do we stay connected? Right. So it's constant follow up and phone calls and being part of the Burke family, we actually all patients that are admitted, we give a card on admission. It says, welcome to the Burke family. We want to keep everyone connected. We're nationally recognized U.S. news and World Report. We're on Newsweek's list of best physical medicine rehab centers in the country, where also our employees voted us best places to work. That has to say volumes.

[A]

It really does. I guess I would conclude then, and you've touched on some of these things already, but what advice would you have for your peers out there, you know, in the healthcare field who look at Burke and say, my gosh, you're just doing so many things right. We'd like to follow their example. What would you share? What are your thoughts about that?

[B]

So, Tom, I would go twofold on the clinical end. Listen to the acute care hospital's challenges help with reducing length of stay. That is what acute hospitals want to hear. It's better for the patient, it's better for the hospital, it's better for everyone. In addition, don't be afraid to swing big and fall hard. Not everything's going to work right. When we did our strategic plan, we threw spaghetti at the wall and see what stuck, right? And we had 53 initiatives. Not every one of them are going to be home runs, grand slams, but we'll hope for some base hits there. And leadership is everything. I start and end my day on the patient units, talking to patients and families and employees. Sometimes you could find me at the front desk welcoming visitors. You could find me at the admission center welcoming new patients. It's really all about presence, visibility, and being humble and caring about your organization and the people we serve.

[A]

It's just a great summation of everything that you guys are doing right. Thank you so much for what you do on behalf of your patients. Thank you for your time joining me on Advancing Health today. And best of luck in everything you're doing and good luck in the future.

[B]

Thank you. It's been my pleasure and thrill.

[A]

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