When inpatient rehab ends, the transition home can feel overwhelming, especially after a stroke, traumatic brain injury (TBI), concussion, head injury, or spinal cord injury. The first days of home rehab often determine whether recovery stays on track or starts to slip. Families may feel unprepared, and safety risks can rise quickly without structure and support.
For discharge planners, case managers, attorneys, funders, and providers, this transition creates a high-stakes coordination moment. A clear transition plan protects continuity of care and reduces the risk of setbacks at home. At NeuroPraxis, we support discharge-to-home transitions with structured, personalized rehabilitation in the home and community. Our experienced clinical team and efficient process help stakeholders coordinate care quickly, so recovery can continue with consistency and clinically appropriate support.
In California, recent legal changes have made proactive planning even more important. A published court decision has changed how ongoing home rehab services may be reviewed and disputed. The “Patterson exception” has been rejected. As a result, continued care may face utilization review (UR) and independent medical review (IMR) more often, even after prior authorization.
What Changed: The Patterson Exception Was Rejected
In November 2025, the California 2nd District Court of Appeal issued a published decision in Illinois Midwest Insurance Agency LLC v. WCAB (Rodriguez), B344044. The court rejected the Patterson doctrine.
In practical terms, the court held that there is no statutory basis for an “ongoing treatment” exception to the state’s utilization review (UR) and independent medical review (IMR) systems. Instead, all proposed medical care, including continuing care, must go through UR. If care is denied or modified, it can be appealed through IMR.
For stakeholders navigating workers’ compensation rehabilitation coverage, this matters. It changes how continued services may be challenged, even when services were previously authorized.
Why This Matters for Stroke Rehab, Brain Injury Recovery, and Spinal Cord Injury Rehabilitation
Recovery from brain injury, stroke, and spinal cord injury rarely follows a straight line. Progress depends on repetition, structure, and consistent carryover of skills into real-world environments. In a facility setting, structure is built in. At home, it often disappears overnight.
When services end abruptly, clients can lose momentum quickly. Families may become overwhelmed. Safety risks can rise and even motivated clients can struggle without a clear plan, a stable routine, and consistent support.
This is why the discharge-to-home phase is so important. It is also why NeuroPraxis focuses on customized, clinically appropriate in-home rehabilitation that supports continuity of care and long-term outcomes.
The Discharge-to-Home Gap Is a High-Risk Moment
Discharge plans often assume a best-case scenario. The client goes home with instructions, follow-up appointments, and a schedule, which is a good plan on paper. But real life can take over fast.
Many families face immediate challenges. Some don’t know how to support a patient’s rehabilitation safely. Others struggle to create the structure recovery requires. Neurofatigue, confusion, or emotional and behavioral changes can derail progress quickly.
For clients recovering from concussion, head injury, or TBI, the home environment can introduce distractions, overstimulation, and unpredictable demands. For clients recovering from stroke or spinal cord injury, the risks may include falls, mobility setbacks, or unsafe transfers.
The gap between “discharged” and “stable at home” is where outcomes can be won or lost.
NeuroPraxis Provides Structured, Personalized Rehab at Home
Not all home rehab support is the same.
Some services focus on basic assistance. Others provide therapy visits without a larger structure. Many families try to piece together help without a unified plan, especially when time is limited and stress is high.
NeuroPraxis provides specialized neurorehabilitation for clients with complex needs. Our work supports recovery where it matters most: in the home and community. We help clients practice skills in real settings, build routines that stick, and reduce the risk of regression after discharge.
Our approach is personalized and customized to each client’s conditions, needs, challenges, and goals at that time. We bring structure and expertise to a person’s daily recovery so progress continues, even when the transition to home happens sooner than expected.
When Authorization Changes, Recovery Still Needs Continuity
Coverage changes can happen unexpectedly with UR and IMR decisions. Funding can shift without warning. However, neurologic recovery doesn’t pause when the paperwork changes.
When rehabilitation is interrupted, clients can quickly lose strength, endurance, and functional skills. They may become less confident and less active. Caregivers can burn out quickly. In some cases, preventable complications might lead to emergency care or readmission.
From a care coordination standpoint, change creates a high-stakes moment. For case managers, attorneys, and funders, it can also lead to avoidable costs over time. Continuity of care protects outcomes. It also protects the progress already made through earlier rehabilitation services.
NeuroPraxis is a leader in home rehab, known for excellence and client-centered care. Our experienced clinical team and efficient process make it easier for stakeholders to coordinate care quickly, reduce disruption, and keep recovery moving forward at home.
What Matters Most: Strong Documentation and Medical Necessity Support
With the Patterson exception no longer recognized, case management and documentation become even more critical. Ongoing rehabilitation requests may need clear and consistent documentation that explains why services remain medically necessary. That includes functional deficits, measurable goals, progress over time, and the risks of stopping care too soon.
This is not just administrative. It directly affects whether clients are able to maintain recovery momentum. NeuroPraxis has expertise in supporting stakeholders by coordinating with treating physicians and care teams, reinforcing clear goals, and helping ensure services remain aligned with clinical need and functional outcomes.
NeuroPraxis Is Here to Support Recovery, Safety, and Best Outcomes
If you are a discharge planner, case manager, attorney, funder, or provider supporting a client after a stroke, concussion, traumatic brain injury (TBI), head injury, or spinal cord injury, the discharge-to-home phase is a critical window that requires careful planning. The Patterson change increases the need for proactive coordination. It also increases the value of a specialized neurorehabilitation partner who can step in quickly with structured, clinically appropriate support.
NeuroPraxis provides personalized home rehab that helps clients stay safe, stabilize routines, and continue progressing after discharge.
When coverage changes, recovery should not collapse.If you are supporting a client who needs continued recovery care, contact NeuroPraxis today for assistance. Call our team at 888.266.8921 to discuss next steps, or send us an email to hello@neuropraxisrehab.com. You can also submit a referral through our website: https://neuropraxisrehab.com/online-referral/.