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Chapter 5. Subacute Care. Long-Term Care: Managing Across the Continuum (Second Edition). Learning Objectives. Define and describe subacute care units Identify sources of financing for subacute care units Identify and describe regulations affecting subacute care units

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Chapter 5. Subacute Care

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Chapter 5 subacute care

Chapter 5. Subacute Care

Long-Term Care: Managing Across the Continuum

(Second Edition)


Learning objectives

Learning Objectives

  • Define and describe subacute care units

  • Identify sources of financing for subacute care units

  • Identify and describe regulations affecting subacute care units

  • Identify and discuss ethical issues affecting subacute care units

  • Identify trends affecting subacute care units into the future and the impact of those trends


What is subacute care

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

Philosophy of Care

Four types:

  • Transitional

  • General

  • Chronic

  • Long-Term Transitional


Ownership of nursing facilities

Ownership of Nursing Facilities

  • Mostly freestanding SNFs (2/3)

    - Rehabilitation focus

  • 1/5 Hospital-based

    - Medical focus

  • Many owned by corporate chains


Services provided

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


Care planning

Care Planning

  • Focus on quality of care & outcomes

  • Initial assessment

  • Interdisciplinary team

  • Weekly team conferences

  • Ongoing evaluation


Case management

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


Consumers of subacute care

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


Market forces

Market Forces

  • Cost-saving efforts

  • Managed care

  • Choice


Regulations

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


Types of regulations

Types of Regulations

  • Medicare

  • OBRA

  • Other – similar to other providers


Accreditation

Accreditation

  • JCAHO

  • CARF

  • NCQA


Financing subacute care

Financing Subacute Care

  • Reimbursement Sources:

    • Medicare – 2/3

      - Pays as SNF

    • Other 1/3:

      - Managed care

      - Medicaid

      - Private pay and other sources


Staffing

Staffing

Interdisciplinary Team:

  • Program Administrator

  • Physicians

  • Nursing

  • Other professional staff

  • Non-licensed staff


Legal ethical issues

Legal & Ethical Issues

  • Meeting Regulations

  • Liability Issues


Management qualifications

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 opportunities

Management Challenges& Opportunities

  • Changing the culture of the organization

  • Balancing cost and quality

  • Coordination, competition

  • Physical facility considerations


Significant trends

Significant Trends

  • Managed care

  • Changes in acuity levels

  • Emphasis on outcomes


In summary

In Summary:

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


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