Assignment Content
In at least 300 words, explain the differences between care and case management. Do you think one is more important than the other? Share your thoughts.
Be sure to include your APA citations/references.
Chapter 5: This week reading material
Course Materials (Available in the Content area of the course): Pratt. J. Long-Term Care- Managing Across the Continuum. 4th edition. Jones and Bartlett ISBN: 978-1-284-05459-0.Long-Term Care: Managing Across the Continuum, Fourth Edition

John R. Pratt


What is Postacute Care?

· Services to patients needing additional support to assist them to recuperate following discharge from an acute hospital.

What is Subacute Care?

· Comprehensive, cost-effective inpatient level of care for patients who have had an acute event.

What is the Difference between Postacute Care and Subacute Care?

Subacute Care
Post-Acute Care

– May be
either after or in place of acute care
– Is
after acute care

– Provides
in-patient services
– Provides
outpatient services

– Provides
medical and nursing care
– Provides
nursing and/or

non-medical care

Postacute Care

· Provided by:

· Inpatient Rehabilitation Facilities

· Long-Term Care Hospitals (LTCH)

· Skilled Nursing Facilities
· Home Health Agencies

· Use of Postacute Care

· About one-third of hospital patients go on to use postacute care. The most common, single, postacute care destination for beneficiaries discharged from acute inpatient care hospitals is a skilled nursing facility.

· Medicare Conditions of Participation – providers must meet different conditions of participation

· Bundled Payments – Like other Medicare-certified providers, post-acute care providers will be impacted by CMS’s Bundled Payments for Care Improvement initiative.
· Readmissions – The Affordable Care Act of 2010 (ACA) reduces payments to hospitals for greater than expected readmissions, decreasing payments for all Medicare discharges in the prior year.

Subacute Care

How did Subacute Care come to be?

· It is one of the fastest growing segments of the health care delivery system.

· Result of pressures to be cost-effective, increased demand for consumer choice, and competition between providers.

Defining Subacute Care

· Comprehensive inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process.

· Goal oriented treatment rendered immediately after, or instead of, acute hospitalization to treat one or more specific active complex medical conditions or to administer one or more technically complex treatments.

Philosophy of Care

· Specific care rendered for very specific reasons (conditions or treatments)

Ownership of Subacute Care Units

· Often provided by existing hospitals or free-standing nursing facilities.

Services Provided

· May include:

· Rehabilitation

· Physical and Occupational Therapy

· Respiratory Therapy

· Cardiac Rehabilitation

· Speech Therapy

· Postsurgical Care

· Chemotherapy

· Total Parenteral Nutrition

· Dialysis

· Pain Management

· Complex Medical Care

· Wound Management

· Ventilation Care

· Other Specialty Care

Care Planning

· Involves assessing each individual patient’s needs, developing a care plan to meet those needs, and constantCHAPTER 5

Subacute and Postacute Care

Learning Objectives
After completing this chapter, readers will be able to:
1.   Define and describe subacute and postacute care for the purpose of clarifying these confusing terms.
2.   Identify where subacute care fits in the continuum of care, the services it offers, and the consumers who use it.
3.   Identify sources of financing for subacute care.
4.   Identify and describe regulations affecting subacute care.
5.   Identify and discuss ethical issues affecting subacute care.
6.   Identify trends affecting subacute care for the near future, and describe the impact of those trends.

■ Introduction

This chapter describes subacute (and postacute) care—an often-misunderstood segment of the continuum of care—discussing its development, reasons for that development, and where it currently fits in the continuum, as well as the nature of the consumers who use subacute care and what they seek from it. It is misunderstood because it contains several elements that frequently overlap and are referenced by different names. The terms 
subacute care and 
postacute care cover some, but not all, of the same services. In fact, discussing both subacute care and postacute care in the same chapter could be called arbitrary. However, we do so in an attempt to bring some clarity to the issue.

We discuss postacute care primarily in the context of explaining the terminology. The chapter explores issues related to financing, staffing, and regulation as they impact subacute care, and it identifies several trends promising such impact in the future.

■ What Is Postacute Care?

Postacute care (PAC)
is designed to improve the transition from hospital to the community. Post-acute care includes the recuperation, rehabilitation, and nursing services following a hospitalization that are provided in skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs), and by home health agencies (HHAs) and outpatient rehabilitation providers. (Dummit, 2011, p. 3)

■ What Is Subacute Care?

While we get to a more detailed definition of subacute care later, for now let us use a simple, straightforward definition. It is “a level of care needed by a patient who does not require hospital acute care, but who requires more intensive skilled nursing care than is provided to the majority of patients in a skilled nursing facility” (CA Subacute Care Unit, 2012). One author suggests we think of subacute care as:
a passageway through which increasing numbers of patients travel. What happens during that experience can range from a set of basic rehabilitation services to a much richer array of therapy, teaching, and medical progress. Medical, and often psychosocial, complexity characterizes subacute care. (Buxbaum, 2009)

■ What Is the Difference Between Postacute Care and Subacute Care?

Both subacute and postacute care are substitutes for acute care, resulting iChapter 5
Subacute and
Postacute Care

Learning Objectives

1. Define and describe subacute
and postacute care

2. Identify where subacute care fits
in the continuum of care

3. Identify sources of financing for
subacute care

Learning Objectives (continued)

4. Identify and describe regulations
affecting subacute care

5. Identify and discuss ethical issues
affecting subacute care

6. 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

 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:
Long-term transitional

Ownership of Subacute Facilities

Mostly freestanding SNFs (two-thirds)
• Rehabilitation focus

• 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
 Wounds
 Cardiac recovery
 Respiratory ventilation
 I.V. therapy or feedings

Market Forces

 Cost-saving efforts
 Managed care
 Choice


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
 Other – similar to other providers


 Joint Commission
 CARF International

Financing Subacute Care

Reimbursement Sources:
Medicare – two-thirds
• Pays as SNF

Other third:
• Managed care
• Medicaid
• Private insurance, self-pay, and other


Interdisciplinary team:
 Program administrator
 Physicians
 Nursing
 Other professional staff
 Nonlicensed staff

Legal and Ethical Issues

 Meeting regulations
 Liability issues

Management Qualifications

 Li

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