Available 8:30 a.m.–5:00 p.m. Our Subacute Services Include: Comprehensive rehabilitation programs (physical, occupational and speech therapies) Pulmonary and respiratory care (ventilator and trach) Advanced wound care; IV antibiotic therapy; Pain management; Cardiac care; Dialysis; Post-surgical care; We provide care education and discharge planning throughout your stay. ACUTE REHABILITATION NURSE. We concluded from our review of the literature and interviews that when the term "subacute care" is used in practice it nearly always refers to patients whose needs fall somewhere between acute hospital care and "traditional" longer-term nursing facility care. In addition, most subacute SNF providers report that patients referred to their facilities were "medically stable.". Sub-acute care provides continuity of care for patients who no longer require hospitalization, but still need skilled medical care in a rehabilitation facility. There is also very little evidence on the effect of subacute care on patient outcomes. Outcomes measures have received more attention as structure and process measures by themselves have become less acceptable as measures of health care quality. Acute Rehabilitation Nurse Resume Example Resume Score: 65%. What Services are Identified with Subacute Care? © 1997- American Speech-Language-Hearing Association. Cared for patients with a wide variety of conditions such as … We found that the term subacute care has come to have two meanings, and that understanding those differences is critical to understanding the entire subacute care phenomenon. Over the next 25 years, the elderly population over age 65 is projected to increase from 34 million to more than 50 million. For a patient to qualify for inpatient rehabilitation they must be able to tolerate 3 hours of therapy per day (speech-language pathology, occupational therapy, physical therapy) at least 5 days per week. A subacute fracture is one that is neither exactly acute or chronic. You can access subacute care in many different settings and it has many benefits. While true, subacute programs in the ideal stress an intensity of focus on outcomes, as well as achieving outcomes in a particularly efficient and lower cost manner. While monitoring quality is costly, the current emphasis on outcomes measurement in this industry might indeed provide strong and effective incentives for continuous quality improvements. As we discussed in Chapter Two, prototypical subacute care is an organized program intensely focused on achieving specified measurable outcomes in an efficient and cost-effective manner. Patient placement into subacute care is determined by a variety of factors, including the patient's insurer. Rehabilitation hospitals and units may have difficulty serving subacute patients and still meet the requirement that 75 percent of patients fall within 10 diagnostic categories. Full-service HHAs are also providing what is otherwise known as subacute care in the home. Most subacute patients are discharged home. Regulatory Barriers. This indicated to us that few have the management and information systems in place needed to track subacute patients, monitor the facility's success, and learn where improvements are required. There is remarkably little evidence that shifting patients sooner from hospitals to subacute care will save money. It is within this context of rising costs and shifting demographics that "subacute care" is being promoted by many post-acute care providers and others as a cost-effective alternative to inpatient acute hospital care. This paper focuses … Evidence that facilities were unable to handle some types of patients that were being admitted, leading to rates of rehospitalization and emergency use that raised some concern. Below you will find a resume Example for health care professional with job experience in Acute Care Nursing. Patients must be medically stable to qualify for SNF level of care. Long-term hospitals serving subacute patients may have difficulty maintaining the required 25 day average length of stay. In general, providers tend to distinguish between "rehabilitation subacute" patients, which include conditions such as hip replacement, spinal cord injuries, and brain injuries. The absence of a specific, agreed-upon definition of subacute care and the evolving nature of the industry make it impossible to determine with any accuracy or reliability the volume of subacute care. Subacute facilities vary in contracting out versus providing in-house therapies and physician services. A national study of the potential savings to Medicare of subacute care is based on several questionable and critical assumptions. In fact, it seems unclear whether many patients referred from SNFs ever actually received home health care requested on their behalf. Finally, ideal subacute care encompasses a set of techniques thought essential to achieving stated goals. Examples are complex wound care and rehabilitation when a patient can not tolerate 3 hours of therapy a day. Physician involvement is said to be a core characteristic of subacute care, but Medicare payment policies coupled with increased travel time may make many physicians reluctant to follow their patients to a SNF. Regulatory barriers including CON requirements and enforcement have a direct impact on the development of subacute care. We did find that Los Angeles had the lowest hospital use rates of the four market areas. Video also available at: http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/video/ Rehospitalization rates vary across settings. NFs in Los Angeles have the lowest occupancy of the four market areas, and California Medicaid NF reimbursement is the only one of the four applicable systems that provides no additional Medicaid dollars to facilities that take patients with heavier care needs, except for technology-dependent patients. Subacute care is partly about a set of patients and conditions: people with health problems too complex for the skills and services of a traditional nursing facility, but not so unstable or sick that an acute care hospital is needed. Again, Los Angeles provides a key example of a market area where the subacute phenomenon is partly driven by NFs search for new payors and markets. A small but growing number of SNFs are being accredited by CARF and JCAHO as subacute facilities. Subacute Care Setting. How are Subacute Care Services Categorized? However, some argue that acute care actually occurs in three stages: emergency care (if needed), immediate care (0-12 hours), and transition care (12 hours to 4 days). Subacute care techniques in the ideal also include the use of critical pathway protocols, and clinical and program evaluation based on measured outcomes. In addition, Medicare managed care plans who offer expanded hospital benefits to attract beneficiaries have incentives to shift beneficiaries to SNFs to reduce their risk. 832 NE 162nd Avenue Portland, OR 97230. We are not aware of any studies that compare outcomes for medical patients either across subacute platforms or between subacute care and acute care or Medicare SNF care. Large chains are generally better positioned to develop subacute care programs based on their ability to access capital markets, achieve economies of scale and operating efficiency, develop integrated post-acute networks, hire specialized staff, and provide higher margin ancillaries through their own related organizations. Some examples include patients recovering from strokes, cardiac, orthopedic, or transplant surgery, patients with chronic or acute pulmonary conditions, brain injury, individuals with acute or chronic wounds, and more. There are only a handful of empirical studies on quality in subacute care facilities, but they generally find poorer outcomes for patients treated in SNFs compared to those treated in rehabilitation hospitals. Patients have similar etiologies, as well, including stroke, head injury, dementia, and complex medical conditions. SAR is time-limited with the express purpose of improving functioning and discharging home. Career Objectives. Some key examples of the undeveloped product include the following: None of the hospital-based SNFs and only a few of the freestanding SNFs we visited are actually using even those clinical outcomes measures (i.e., the FIM) that are currently available; Few of the state-of-the-art facilities we visited could easily produce minimal data (e.g., length-of-stay by patient characteristic or program type) for the patients they called subacute. In particular, the inaccuracy of the OSCAR national data suggests that its information on subacute care patients should be interpreted with great caution. But some conditions and patients within that old and broad category - the unhealed decubitus patient, the "unweanable" ventilator patient, those "old people" with strokes thought "unlikely" to recover much function - are clearly benefiting just by virtue of the new attention. What is the primary purpose of PostAcute Care, and what are some common HCO examples? Instead, it has been the journey itself that has led to an understanding of the concept. Many patients with acute illness or injury require comprehensive care that includes frequent assessments and procedures to manage their condition. There are, however, daily visits from nurses and other staff to stay on top of the patient’s situation in case there are any changes that need a quick response. We found that: There is both competition and cooperation among providers. Subacute care … With new attention, some old problems may prove to have solutions. Acute and subacute injuries are the first two stages of what can become long-term pain. A wide range of patients are treated in facility-based subacute care settings from traditional Medicare skilled to gravely-ill, but clinically stable ventilator patients have also been deemed suitable for this type of care. The cost-saving arguments are based principally on the fact that per diem costs in a subacute care setting may be as much as 40 to 60 percent less than hospital acute care, but there are many other considerations involved in realizing savings discussed in the study. However, California is reviewing its CON policies, and new regulations may have an effect on any further development of subacute care. In general, patients in all of these provider types could be classified as either "rehabilitation subacute" or "complex medical subacute." However, the majority of nursing associations with which we spoke had concerns about the whether SNFs were staffed appropriately for the acuity of patients being referred and the quality of care provided. Medicare's payment systems for acute care have led to increased demand for post-acute care services for higher acuity patients. You do not have JavaScript Enabled on this browser. Rehabilitation . Researchers' difficulties identifying and collecting data on subacute care providers are not limited to large data bases. There is nothing new about SNFs, long-term care hospitals, or rehabilitation facilities caring for the types of patients noted above, except perhaps that such patients (particularly those at the highest level of acuity) may constitute a larger proportion of patients in today's SNFs. We acknowledged the following developments: Two accreditation organizations have established subacute care standards. In particular, ALOS is dependent on the severity of the patient's condition. Adhere to the Centers for Medicare & Medicaid Services (CMS) dementia care initiative to reduce the use of antipsychotic medications in treating residents with dementia. Once you enter the Kerr campus, follow signs for Crisis Psychiatric Care (Subacute). Specifically, managed care groups are more likely to play a role in determining a patient's discharge destination than other payors. As compared with … This study was prepared for the Department of Health and Human Services , Office of the Assistant Secretary for Planning and Evaluation. There is no distinct Medicare payment system for subacute care. B. Three of these similarly conclude that outcomes were better for those treated in hospitals. Finally, we found critical gaps in information needed by both the public and private sectors. Special resources to achieve those goals include more and better trained staff (than in a "traditional" SNF), especially physicians and nurses. Thus, the term "subacute care" has come to be used to refer to a level of care -- skilled care for patients with complex needs -- that some nursing facilities, home care providers, and others have been providing for years under a variety of different names (e.g., "high-end skilled care"). The observation of a general reluctance of physicians to visit patients in SNFs disputes the common claim that subacute care is physician-directed. These physiological responses may reach gr… The volume of "ideal" subacute care, as described above, can not be determined from national data sets because the distinguishing characteristics of subacute care are not captured on any of the large national data bases. In contrast, acute indicates very sudden onset or rapid change, and chronic indicates indefinite duration or virtually no change. Subacute care provides a specialized level of care to medically fragile patients, though often with a longer length of stay than acute care.   SAR is typically provided in a licensed skilled nursing facilty (SNF). Please enable it in order to use the full functionality of our website. But, we also found substantial evidence of a movement to create a new type of program to service those patients, a new approach to care, different from traditional Medicare "high-end" skilled care. Nevertheless, reflecting both on what we saw in the field and have observed in the industry press and other literature, it is clear that much that is called "subacute care" is really just a new name for higher acuity, medically complex patients and/or those requiring more intensive therapies. Explain the emergence of SubAcute Care (from a care & cost-saving perspective). However, from our interviews with managed care firms, we estimate that the daily rate for a subacute stay ranged from $127 to $450 in Los Angeles, from $500 to $850 in Boston, from $420 to $750 in Ohio, and from $175 to $585 in Miami. Some also contract out physician and nursing services, as well as the services of other specialists. Fourth, while the new subacute care offers considerable promise, realizing that promise poses substantial challenges for both the public and private sector. Much of the available evidence relies on comparisons of costs per day or on questionable assumptions about use and length of stay. CHAPTER THREE examines the growth of subacute care including the key factors currently shaping the industry. Few facilities currently are collecting data on quality or clinical outcomes. The Functional Independence Measure (FIM) is the best known measure for assessing outcomes for rehabilitation patients and is being used to measure subacute rehabilitation outcomes. Our Location. Subacute care takes place after or instead of a stay in an acute care facility. CHAPTER FOUR examines the state-of-the-art in subacute care based on our site visits at 19 facility-based subacute care providers, telephone interviews with four representatives of three national firms specializing in home infusion therapy (so-called "high tech") home health care, six representatives of five "full-service" home health agencies (HHAs), discharge planners, managed care planners, managed care groups, physicians, patient care advocates, state nursing home associations, state hospital associations, state nurses associations, and state Medicaid officials. The term "subacute" is increasingly used to describe a set of patients that in the past were described by other terms such as "High-End Medicare Skilled." Finding the Right Skilled or Subacute Program. Examples of how to use “subacute” in a sentence from the Cambridge Dictionary Labs In some cases, subacute SNF facilities are competing with long-term care and rehabilitation hospitals for discharges. Emergency interventions and services should be integrated with primary care and public health measures to complete and strengthen health systems. The exact degree of physician and licensed nurse involvement required is a matter of some debate, particularly since increasing the involvement of highly-trained staff increases costs. It was not uncommon to find, for example, state-of-the-art providers who called a portion of a Medicare and/or dually-certified unit the "subacute care" wing or unit, but whose routine data systems did not distinguish those patients from others. In summary, our conclusions are: First, the emerging concept of subacute care is compellingly attractive both in the new attention it brings to some types of patients and in regard to the type of programs envisioned in the ideal. First, the increased metabolic demand associated with muscle contractions provokes a plethora of physiological adjustments that enhance oxygen and micronutrient delivery to the working muscles. Subacute providers are developing specialized programs for certain types of patients. The key factors influencing the growth of subacute care in each market area include: Managed Care: Managed care is said to be the driving force behind the development of the subacute care industry, yet across all markets and platforms included in our study, Medicare fee-for-service is still the dominant payor. Specific findings include: The growth of subacute care has been attributed largely to the growth of managed care, though we found that most of the patients in the facilities we visited we paid for by Medicare. Two. At heart, the new subacute care promises to provide greater "value" than other forms of care: similar or better quality for lower cost. infant care in the nursing interventions classification, a nursing intervention defined as the provision of developmentally appropriate family-centered care to the child under one year of age. Proponents argue that subacute care has the potential for public and private savings and possibly improving patient outcomes. Subacute patients may be "scattered" across units of subacute care or located in a dedicated wing; unit boundaries frequently do not correspond to Medicare/Medicaid unit boundaries. Market Inefficiencies. However, California is reviewing its CON policies, and new regulations may have an effect on any further development of subacute care. ET Monday–Friday, Site Help | A–Z Topic Index | Privacy Statement | Terms of Use CHAPTER SIX analyzes evidence regarding the cost, quality, and effectiveness of subacute care. What is the effect of subacute care on the total cost of the episode of care? In part, this may be a function of the presence of more aggressive managed care arrangements in Los Angeles, compared to other market areas. A person’s functioning may relate to their whole body or a body part, the whole person, or the whole person in a social context, and to impairment of a body function or structure, activity limitation and/or participation restriction. Some providers may not mean to imply anything else by the use of the term than a reference to patients with somewhat higher care needs (both medical and rehabilitative) than the average. A career objective is used to clearly document the job target. Respondents raised questions about staffing qualifications, the role of managed care in HHAs, access issues for lower-income patients, the perception of a "no care zone" for patients with lower acuity, and the fact that Medicare reimbursement for home infusion therapy remains a barrier to appropriate home infusion therapy as compared to the provision of infusion in an SNF. The acceleration of interest in quality also has increased interest in the ability to compare outcomes within similar types of providers and across different types of settings. Estimates of the current annual volume of subacute care range from 1.2 million to 8.1 million patient days. Regulatory Barriers. In general, the ratio of RN time compared to LPN and CNA time is greater in subacute SNFs than among traditional nursing homes. In Oregon, common examples of QMHPs include: psychiatrist, mental health therapist, social worker, psychologist, psychiatric nurse-practitioners. The primary financial and organizational factors shaping the development of subacute care nationally include the efforts of managed care providers to find more cost-effective types of care, the implementation of new Medicare payment policies applicable to acute and post acute care providers, and changes in patient preferences. During recuperation, patients receive rehabilitation in a skilled nursing facility, where they stay overnight until therapy goals are met. Facility-based (institutional) subacute care providers, particularly skilled nursing facilities, have been a driving factor in the development of the subacute care phenomenon. Build Your Own Now . In the future, the growth of managed care might foster the development of more subacute care as managed care providers seek less costly alternatives to hospital acute care. For example, a hospital may provide high-quality acute care during a cardiac health crisis, but it might not be the best place for cardiac rehabilitation. The value of subacute nursing home care Case studies have shown that the costs of subacute nursing home care are significantly less than hospital or traditional rehabilitation centers. In the second study, rehabilitation patients treated in the subacute SNF had significantly higher death rates and emergency rehospitalizations than patients treated in the hospital when controlling for age. These traditional HHAs are said to receive substantial numbers of discharges from subacute facilities, but we were unable to verify this reported trend. This group of patients includes those with cardiovascular diagnoses, cancer, ventilator care, wounds, and IV therapy. Supervised and administered care to hospice patients with acute conditions and exacerbation of terminal illness requiring in-patient acute level care. The questionable assumptions concern length of stay and use, estimates of SNF costs, and bed availability. As is now widely understood, without some changes made to the current system, Medicare expenditures for post-acute care and for acute care are expected to rise substantially as both the number and proportion of persons over age 65 grows. Setting-specific barriers differentially affect the ability of providers to develop subacute programs. Nevertheless, it is our subjective conclusion that activity and apparent quantity of subacute care are greatest in Los Angeles, followed by Miami, Boston, and Columbus, in that order. In response to the growing potential for substitution of home health care for facility-based subacute care, many informants expressed additional quality concerns regarding HHAs. Medicare coverage and payment policies present barriers unique to provider type. The average length of stay (ALOS) varies among subacute patients. Subacute care; waiver from state and federal rules and regulations. Ideal subacute care encompasses a set of techniques thought essential to achieving stated goals. Supervised care team consisting of the RN (myself), an LPN and CNA's. However, long-term hospitals and rehabilitation hospitals have readmission rates that are similar to each other and appear somewhat lower than those of the SNFs. In long-term and rehabilitation hospitals, physician participation in patient care appeared to be slightly greater. Of the providers who do collect outcome data, the data measure most often used is limited to rehabilitation subacute and it does not adjust for medical severity. Some providers are successfully applying key elements of the subacute care concept in their programs. Ohio has recently changed its CON, and it is unclear what the impact will be on the development of subacute care. Although the new subacute care is evolving through both practice and debate, we believe that at the time of this writing (September, 1995) the core elements of this idealized, prototypical subacute care include those highlighted below. The development and use of accreditation standards are influencing the subacute care industry through the establishment of minimum standards and broadly defined quality guidelines. The lower number may be a reasonable estimate of subacute care in the first sense of "higher acuity" patients, but both figures substantially overcount the actual volume of subacute care under the second definition. Medicare is the dominant payor of subacute care. This section provides examples of the benefits of subacute care … This estimate excludes rehabilitation hospital and units, long-term hospitals and home health agencies from the definition of subacute care providers. Assistant Secretary for Planning and Evaluation, Room 415F, U.S. Department of Health & Human Services, National Council on Vital and Health Statistics, Behavioral Health, Disability, and Aging Policy, Patient-Centered Outcomes Research Trust Fund (PCORTF), Public Health Emergency Declaration – PRA Waivers, Social Determinants of Health and Medicare’s Value-Based Purchasing Programs. Examples of Subacute care in a sentence Sub-acute care lasts for a limited time or until a condition is stabilized or a predetermined treatment course is completed. Speech-language pathologists working in subacute units provide the same range of services seen in inpatient rehabilitation and skilled nursing facilities, including speech, language, cognitive-communication, and swallowing treatment. Subacute: Rather recent onset or somewhat rapid change. While all researchers face difficult challenges, we believe that in this case the difficulties we encountered both in finding subacute providers in reportedly better developed markets and in obtaining data on subacute patients are an important part of our findings. In our market area study, we did not visit different facilities owned by the same corporation. Hudson View has staff specifically trained in subacute care and an environment geared toward progress in rehabilitation. To this end, there is a critical need for carefully evaluated demonstrations designed to assess the likely impact of ideas related to increased use of subacute care. The four institutional provider types or "platforms" we studied were nursing facilities (freestanding and hospital-based), rehabilitation hospitals, distinct-part rehabilitation units, and long-term hospitals. For example, the American Health Care Association includes "efficient and effective utilization of health care resources" in its short definition of subacute care. SERVICES, SETTINGS, AND PROVIDERS A. Accreditation is likely to be of growing importance in the development of subacute care, but current standards appear to allow a wide range of quality and services under the "accredited" stamp of approval. If the person cannot tolerate this much therapy or no longer requires therapy at this intensive a level, they may be better served at the subacute level. For example, in Los Angeles, the lack of CON requirements has encouraged the development of subacute care. In addition, publicly-traded growth companies need to continue to grow profits to maintain their stock prices.. WHAT DO PEOPLE MEAN WHEN THEY REFER TO SUBACUTE CARE? To a large extent, these are the same patients who in the not-very-distant past, were called "Medicare high-end skilled," or simply, "heavy care skilled" patients. Finally, public and private payors determined to reduce health care spending should ideally know the likely impact of specific changes before they are implemented. The development and use of outcomes measures are influencing the market for subacute services by becoming an increasingly important component of subacute care programs. Despite the recognized importance of greater involvement of better-trained staff (especially physicians and nurses) to the new subacute care concept and product, we found among the freestanding SNFs we visited (with a few notable exceptions): Little physician involvement beyond that required by existing Medicare/ Medicaid certification standards. We believe that we were privileged to see examples of facilities in this segment that are indeed striving to and in many ways achieving many of the goals of the new subacute care movement. Examples include charting and scheduling. But industry leaders do mean something more, and more is expected if subacute care is to be something other than "old wine in new bottles.". In order to assess what has been increasingly reported as a substitution of home health services for subacute services, we interviewed two types of home health providers: home infusion therapy or "high tech" and "full service" HHAs. One. The statement emphasizes 10 years of experience as an acute care nurse in outpatient clinic environment. The term "subacute care" was in the past used to describe hospitalized patients who failed to meet established criteria for a medically-necessary acute stay, but is now used almost exclusively to refer to patients treated in settings other than acute care beds. Gaps in information needed by both the public and private sector ; the severity of appeared... Very sudden onset or rapid change, and IV therapy current and potential.... 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