Subacute and
Postacute Care
Learning Objectives
Define and describe subacute and postacute care
Identify where subacute care fits in the continuum of care
Identify sources of financing for subacute care
Learning Objectives (continued)
Identify and describe regulations affecting subacute care
Identify and discuss ethical issues affecting subacute care
Identify trends affecting subacute care for the near future and the impact of those trends
What is Postacute Care?
Postacute care:
Improves transition from hospital to the community
Provides services to patients needing additional support following discharge from the hospital
Postacute Care Providers
Include:
Inpatient rehabilitation facilities
Long-term care hospitals
Skilled nursing facilities
Home health agencies
What is Subacute Care?
Comprehensive inpatient care
Comes after, or instead of, acute care
Between acute and long-term care
Usually for a defined period of time
Developed largely for cost savings
Philosophy of Care
Four types:
Transitional
General
Chronic
Long-term transitional
Ownership of Subacute Facilities
Mostly freestanding SNFs (two-thirds)
Rehabilitation focus
Hospital-based
Medical focus
Many owned by corporate chains
Services Provided
• Rehabilitation • Chemotherapy
• Physical therapy • Parenteral nutrition
• Occupational therapy • Dialysis
• Respiratory therapy • Pain management
• Cardiac rehabilitation • Complex medical care
• Speech therapy • Wound management
• Postsurgical care • Ventilation care
• Other specialty care
Care Planning
Focus on quality of care and outcomes
Initial assessment
Interdisciplinary team
Weekly team conferences
Ongoing evaluation
Case Management
Focus on efficiency, cost-effectiveness
Manage resources to optimize outcomes at lowest cost
Case managers may be:
“External” – hired by payer
“Internal” – hired by provider
Consumers of Subacute Care
Post hip-replacement surgery
Spinal cord or brain injuries
Strokes
Cancer
AIDS
Wounds
Cardiac recovery
Respiratory ventilation
I.V. therapy or feedings
Market Forces
Cost-saving efforts
Managed care
Choice
Regulations
Purpose of regulations:
Care is safe and of high quality
Care is not unnecessarily expensive
Services are uniformly accessible
Rights of workers are protected
Types of Regulations
Medicare
OBRA
Other – similar to other providers
Accreditation
Joint Commission
CARF International
NCQA
Financing Subacute Care
Reimbursement Sources:
Medicare – two-thirds
Pays as SNF
Other third:
Managed care
Medicaid
Private insurance, self-pay, and other
Staffing
Interdisciplinary team:
Program administrator
Physicians
Nursing
Other professional staff
Nonlicensed staff
Legal and Ethical Issues
Meeting regulations
Liability issues
Management Qualifications
Licensed by the states as nursing facility administrators
Hospital-based units must find a licensed administrator or get one of the hospital administrators licensed
Management Challenges
and Opportunities
Changing the culture of the organization
Balancing cost and quality
Coordination, competition
Physical facility considerations
Significant Trends
Managed care
Changes in acuity levels
Emphasis on outcomes
Summary
Subacute care is the newest form of long-term care, falling between acute and long-term care.
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