Admission to rehabilitation centers: selection of patients.

Patients are selected for admission to rehabilitation centers. Some patients are too sick or medically unstable to treat; others' disabilities are irremediable. Resources should not be expended upon patients who will not benefit from treatment. The current process of patient selection requires providers to consider both medical and nonmedical factors. Medical factors include diagnosis, prognosis, secondary complications, functional performance and prognosis, and ability to learn. Nonmedical assessment includes social, vocational, financial, and personal factors. There is a potential for subjectivity in the way these variables are considered. Practitioners may be unaware of bias in their decision-making. Patients may be disadvantaged by lack of family or financial resources. Both providers and patients suffer when providers are forced by expectations of utilitarianism to deny treatment to deserving patients. It would be helpful if patients and families were informed about the process of selection of rehabilitation candidates and given the right of redress if rejected. Guidelines delineating standards for admission to rehabilitation centers could assist patient selection. Finally, rehabilitationists must seek to further demonstrate the efficacy of their treatment in order to better identify persons who will benefit from rehabilitation services.