Chapter 5. Subacute Care

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Chapter 5. Subacute Care

• Long-Term Care Managing Across the Continuum
• (Second Edition)

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Learning Objectives

1. Define and describe subacute care units
2. Identify sources of financing for subacute care
   units
3. Identify and describe regulations affecting
   subacute care units
4. Identify and discuss ethical issues affecting
   subacute care units
5. Identify trends affecting subacute care units
   into the future and the impact of those trends

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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

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Philosophy of Care

• Four types
• Transitional
• General
• Chronic
• Long-Term Transitional

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Ownership of Nursing Facilities

• Mostly freestanding SNFs (2/3)
• - Rehabilitation focus
• 1/5 Hospital-based
• - Medical focus
• Many owned by corporate chains

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Services Provided

• Rehabilitation Chemotherapy
• Physical Therapy Parenteral Nutrition
• Occupational Therapy Dialysis
• Respiratory therapy Pain Management
• Cardiac Rehab Complex Medical
• Speech Therapy Wound Management
• Postsurgical Care Ventilation Care

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Care Planning

• Focus on quality of care outcomes
• Initial assessment
• Interdisciplinary team
• Weekly team conferences
• Ongoing evaluation

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Case Management

• Focus on efficiency, cost-effectiveness
• Manages resources to optimize outcomes at lowest
  cost
• May be
• - External - hired by payer
• - Internal - hired by provider

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Consumers of Subacute Care

• Post-hip-replacement surgery
• Spinal cord or brain injuries
• Strokes
• Cancer
• AIDS
• Wounds
• Cardiovascular diseases
• Respiratory ventilation
• I.V. therapy or feedings

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Market Forces

• Cost-saving efforts
• Managed care
• Choice

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Regulations

• Purpose of regulations
• Care is safe and of high quality
• Care is not overly expensive
• Services are uniformly accessible
• Rights of workers are protected

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Types of Regulations

• Medicare
• OBRA
• Other similar to other providers

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Accreditation

• JCAHO
• CARF
• NCQA

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Financing Subacute Care

• Reimbursement Sources
• Medicare 2/3
• - Pays as SNF
• Other 1/3
• - Managed care
• - Medicaid
• - Private pay and other sources

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Staffing

• Interdisciplinary Team
• Program Administrator
• Physicians
• Nursing
• Other professional staff
• Non-licensed staff

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Legal Ethical Issues

• Meeting Regulations
• Liability Issues

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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

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Management Challenges Opportunities

• Changing the culture of the organization
• Balancing cost and quality
• Coordination, competition
• Physical facility considerations

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Significant Trends

• Managed care
• Changes in acuity levels
• Emphasis on outcomes

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In Summary

• Subacute care is the newest form of long-term
  care, falling between acute and long-term care.