Long-Term Care: Managing Across the Continuum (Second Edition) 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 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? 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 Nursing Facilities Mostly freestanding SNFs (2/3) - Rehabilitation focus 1/5 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 Rehab • Complex Medical • Speech Therapy • Wound Management • Postsurgical Care • Ventilation Care

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

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 Post-hip-replacement surgery Spinal cord or brain injuries Strokes Cancer AIDS Wounds Cardiovascular diseases 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 overly expensive Services are uniformly accessible Rights of workers are protected

Types of Regulations Medicare OBRA Other – similar to other providers

Accreditation JCAHO CARF NCQA

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

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

Legal & 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 & 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

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