Chapter 5Subacute andPostacute CareLearning .docx

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Chapter 5 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 Challe.

Education

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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