Discussion Topic- Subacute care

Chapter 5 Subacute and Postacute Care

Learning Objectives

1. Define and describe subacute and postacute care

2. Identify where subacute care fits in the continuum of care

3. Identify sources of financing for subacute care

Learning Objectives (continued)

4. Identify and describe regulations affecting subacute care

5. Identify and discuss ethical issues affecting subacute care

6. 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.