Who is on the rehab team?

Somewhere around day three, most families realise they have met a dozen people and cannot reliably name what any of them do. Everyone is friendly, everyone is busy, and questions keep getting answered with I'll pass that along.

The roles themselves are worth knowing. What follows is the more practical version: what each one can actually decide, and who to bring a given question to.

Who will you actually see the most?

A certified nursing assistant. Not the nurse, not the physician, not the therapist.

CNAs do the hands-on work of the day — bathing, dressing, toileting, transfers, meals, repositioning. They are in the room more than everyone else combined, and they usually notice a change before it appears in anyone's notes. A CNA who says she seemed more confused this morning is giving you real clinical information from the person best placed to have it.

They cannot change medications, adjust therapy, or alter the discharge plan. What they can do is tell you what is actually happening hour to hour, and escalate to the nurse. Treating that relationship as peripheral is the most common mistake families make.

What do PT, OT, and speech therapy each do?

All three are called therapy, which obscures three quite different jobs.

• Physical therapy works on the lower body and mobility — standing, walking, balance, stairs, transfers, strength. If the question is will she walk again, this is the person.
• Occupational therapy works on the tasks of daily life — dressing, bathing, toileting, getting in and out of a kitchen. If the question is can she manage at home, OT usually has the most grounded answer, because that is precisely what they assess.
• Speech-language pathology covers swallowing, speech, and thinking. The swallowing part surprises people. If a diet has been changed or thickened liquids appear, an SLP made that call.

Therapists document progress toward specific goals, and that documentation is what coverage decisions rest on. When a stay is reviewed or ends, therapy notes are the evidence.

What is the difference between an RN, an LPN, and a CNA?

Three different licences, three different scopes, and the distinctions matter when you need something specific.

A registered nurse carries the broadest scope — assessment, care planning, and clinical judgment about changes in condition. A licensed practical nurse handles medications, treatments, and monitoring, working within a plan set by an RN or physician. A certified nursing assistant provides personal care and reports observations.

Exact boundaries are set by state law and vary, so the honest advice is to ask rather than assume. But if something clinical has changed and you need a judgment rather than a task, you are asking for a nurse.

Who is the doctor here?

This is where the confusion is thickest, because there are usually several, and they do different things.

• The attending manages day-to-day medical care — most often internal medicine or family medicine, sometimes geriatrics. This may be a physician, a nurse practitioner, or a physician assistant.
• Physiatry — physical medicine and rehabilitation — is frequently involved alongside the attending, specifically for the rehabilitation side. That is the role I fill.
• The medical director oversees clinical policy for the facility as a whole. They are usually not your family member's treating provider, and asking them about an individual case routes you back to the attending.
• Consultants — cardiology, wound care, psychiatry — appear for specific problems and leave.

Families frequently assume one person is directing everything. Two or three usually are, and asking at the nursing station who is the attending, and who else is following her? takes ten seconds and prevents a great deal of confusion.

Who to ask for what

When something is not being addressed

1. Start with the charge nurse on shift, and be specific about what you observed and when.
2. If unresolved, ask for the director of nursing — the clinical leadership role in the building.
3. Ask for a care plan meeting. Residents and families can request one; they are not held only on the facility's schedule. You can invite an ombudsman to attend with you.
4. File a grievance, and ask for the grievance official by name. Federal regulation at 42 CFR § 483.10(j) requires every Medicare- and Medicaid-certified facility to maintain a written grievance policy, designate a named grievance official rather than a department, and give you a written decision. Asking "who is your grievance official?" changes the conversation, because it names one person as accountable.
5. Call the long-term care ombudsman. Established under the Older Americans Act and administered federally by the Administration for Community Living, the programme is free, independent of the facility, and exists specifically to advocate for residents. The national locator line is 800-677-1116. The facility is also required to make the state ombudsman's contact details available to you.

Escalating is not hostile. Facilities expect it, the pathways exist because they are meant to be used, and being the family that asks clear questions early is the version staff generally find easiest to work with.