Chapter 5. Subacute Care

1. Chapter 5. Subacute Care Long-Term Care: Managing Across the Continuum (Second Edition)

2. 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

3. 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

4. Philosophy of Care Four types: • Transitional • General • Chronic • Long-Term Transitional

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

6. 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

7. Care Planning • Focus on quality of care & outcomes • Initial assessment • Interdisciplinary team • Weekly team conferences • Ongoing evaluation

8. 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

9. 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

10. Market Forces • Cost-saving efforts • Managed care • Choice

11. 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

12. Types of Regulations • Medicare • OBRA • Other – similar to other providers

13. Accreditation • JCAHO • CARF • NCQA

14. Financing Subacute Care • Reimbursement Sources: • Medicare – 2/3 - Pays as SNF • Other 1/3: - Managed care - Medicaid - Private pay and other sources

15. Staffing Interdisciplinary Team: • Program Administrator • Physicians • Nursing • Other professional staff • Non-licensed staff

16. Legal & Ethical Issues • Meeting Regulations • Liability Issues

17. 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

18. Management Challenges& Opportunities • Changing the culture of the organization • Balancing cost and quality • Coordination, competition • Physical facility considerations

19. Significant Trends • Managed care • Changes in acuity levels • Emphasis on outcomes

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