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