New England Baptist Hospital joint replacement recovery in Boston: how to decide between home, rehab, or a short assisted living stay before surgery day.
By Boston Senior Advisor Care Team · October 8, 2026
Families who choose New England Baptist Hospital for a hip or knee replacement usually do so because of its orthopedic focus, and the surgery itself tends to be the part everyone has researched. The part nobody has researched is the Tuesday afternoon, two or three days later, when a discharge planner asks where your parent is going next. For an older adult living alone in Jamaica Plain, Roslindale, or a third-floor walk-up in Mission Hill, that question has three realistic answers: home with outpatient or visiting therapy, a short stay in a skilled nursing facility for rehabilitation, or a temporary stay in an assisted living residence. Each answer changes what Medicare pays, what a family pays, and how much of the work lands on a daughter or son. Settling the likely answer before surgery, rather than during discharge week, is the single most useful thing a family can do.
The reason timing matters is that hospitals plan discharges quickly after planned orthopedic surgery. A patient who is medically stable, walking with a walker, and managing pain can be ready to leave sooner than a family expects. If nothing has been arranged, the default tends to be whichever bed is open nearest the hospital, not the one that fits your parent. Asking the surgeon's office in advance how recovery typically goes for patients with your parent's age, home setup, and support at home gives you a realistic starting point. Write the answer down, share it with siblings, and revisit it at the pre-operative visit.
Medicare's skilled nursing facility benefit generally depends on a qualifying inpatient hospital stay of at least three days, and the days count only when the patient has been formally admitted as an inpatient. Planned joint replacements are commonly handled as inpatient admissions, but the label on the paperwork is worth confirming rather than assuming, and our guide to observation status at Mount Auburn Hospital explains why that distinction can decide whether rehab is covered. When the stay qualifies and the patient needs daily skilled therapy or nursing, Medicare may cover a stay in a skilled nursing facility, with coverage shrinking and a daily copayment beginning after the early days. This is the same benefit period that makes the 100-day clock in our Spaulding Rehabilitation Hospital guide so important to plan around.
What Medicare does not cover is custodial help: someone to bathe, dress, cook, and stay overnight. A family that assumes the rehab benefit also pays for a caregiver at home is often surprised, and our Medicare home health versus in-home care guide for Boston families lays out that gap. Ask the hospital case manager, in plain words, which days of the stay Medicare counts, what the daily cost is if rehab runs long, and who at the facility will tell you when coverage is about to end. Request that answer in writing if possible.
Going home is often the best outcome and the cheapest, but only if the home cooperates. In dense Boston neighborhoods the barrier is rarely the surgery; it is the stairs. Triple-deckers in Mission Hill, Roxbury, and Dorchester frequently have a flight of porch steps and another flight inside, and a parent using a walker cannot safely manage either alone in the first weeks. Before surgery, walk the route from the street to the bed and to the bathroom with a tape measure and an honest eye. Remove loose rugs, add a second handrail, set up a first-floor sleeping area if one exists, and place a shower chair and raised toilet seat before the surgery date rather than after. Our guide to aging in place in a Boston triple-decker covers the stair problem in more depth.
Medicare home health, when your parent qualifies, can send a visiting nurse and physical therapist to the home for a limited course of skilled care. Outpatient physical therapy, by contrast, requires getting to appointments, which is a real obstacle for a person who does not drive. Boston's MBTA is an asset only if your parent can climb into a bus or reach an Orange Line or Green Line station comfortably in the first weeks, which most cannot. Ask whether visiting therapy is available at home, and whether the hospital's discharge team can arrange it before your parent leaves.
Some older adults do not need daily skilled nursing but cannot be alone for a few weeks. Massachusetts assisted living residences certified by the Executive Office of Elder Affairs under M.G.L. Chapter 19D can often offer a short stay, described as respite or a trial stay, that supplies meals, medication reminders, and help with bathing while the surgical site heals. Medicare does not pay for assisted living room and board, so the family pays privately. Assisted living in Greater Boston generally runs roughly $5,800 to $8,200 a month, so a stay of several weeks is a real expense, though often less than a family fears if the residence prorates the stay. Our respite care guide describes what a short stay involves and how to ask about it.
The strongest case for this route is the parent who lives alone, has no one to stay overnight, and whose home has stairs that will not be safe for several weeks. It can also work when a spouse who is the usual caregiver is not strong enough to help with transfers. Call two or three residences before surgery, ask whether they accept short-term guests, how they handle therapy visits, and what they need from the surgeon's office. A residence in Brookline, Newton, or Cambridge will price differently from one in Dorchester or Quincy, so compare more than one.
Divide the work early. One sibling can own the medical side: the surgeon's office, the pre-operative visit, the medication list, and the Medicare questions. Another can own the home side: stairs, equipment, groceries, and rides. A third can own the money side: what Medicare is likely to cover, what private payment would look like, and whether MassHealth or the Frail Elder Waiver is a realistic option now or later. If your parent's income is modest, call the local Aging Services Access Point, which is Ethos for Boston and Springwell for Newton, Brookline, Watertown, and Waltham, to ask about home-based supports before the surgery date. MassOptions at 1-800-243-4636 can point you to the right agency.
Finally, agree on a fallback. If the plan is home and the first week goes badly, who decides to move to a short rehab or assisted living stay, and who makes the calls that day? A written, shared plan removes the argument at the worst possible moment. Keep the surgeon's phone number, the ASAP number, and the Elder Protective Services line at 1-800-922-2275 on the refrigerator in case something at home concerns you. Review the plan again the week before surgery, because a parent's strength and willingness to accept help often change as the date nears.
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