Define and describe subacute and postacute care

Subacute and
Postacute Care

Learning Objectives

Define and describe subacute and postacute care

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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 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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