Patients admitted to the hospital for a serious illness, injury, or worsening medical condition are often discharged before they can fully recover. Patients who have recovered enough to leave the hospital but still require more medical care than a typical doctor’s office can provide will benefit from subacute care. There are many types of subacute care, including full hospital-like facilities dedicated to subacute care, live-in facilities, day programs, and home-visit programs. This article will discuss some of the conditions that often require subacute care, and how patients can benefit from subacute care
What Happens in Subacute Care?
All patients in subacute care receive medical treatments and therapies focused on improving their ability to return to the activities they performed in their daily lives before their illness or injury. The exact treatments and therapies provided will vary based on the patient, how severe their disability is, their personal goals, and what condition led to them being hospitalized. All patients in subacute care receive some or all of the following:
- Physical therapy
- Occupational therapy
- Speech therapy
- Dietary therapy and nutrition counseling
- Mediation adjustments
- Medical and surgical follow-up visits
- Assistance with coordinating follow-up visits
Cardiac and Vascular Conditions
Cardiac and vascular conditions affect the heart and large blood vessels. According to the American Heart Association, 48% of Americans will experience a cardiac condition at some point in their lives. This makes heart conditions one of the most common reasons patients require subacute care. These conditions include:
- Myocardial infarction (heart attack)
- Heart failure
- Cardiomyopathy
- Myocarditis
- Peripheral vascular disease
- Hypertensive emergency
Cardiac conditions can affect patients of all ages but are most common in the middle-aged and the elderly. Many people in their 50’s and 60’s have cardiac events that can lead to severe lifelong disability if they do not receive adequate subacute care. In addition to the treatments all patients in subacute care receive, patients with cardiac conditions receive treatments and therapies focused on strengthening and supporting the heart. These include:
- Light weightlifting
- Resistance band training
- Treadmill and bike exercise
- Diet counseling
Neurologic Conditions
Neurologic conditions affect the nervous system, which includes the brain, spine, and all of the nerve branches that control the muscles and organs of the body. Stroke is the most common nervous system disorder and mainly affects the elderly. However, there are many other neurologic conditions that affect patients of every age. The most common neurologic conditions that can benefit from subacute care are:
- Stroke
- Chronic pain
- Epilepsy
- Cerebral palsy
- Parkinson’s disease
- Muscular dystrophy
- Vision or hearing loss
- Peripheral nerve injury (neurapraxia, axonotmesis, and neurotmesis)
Some of the most unique treatments and therapies in subacute care are used to treat neurologic conditions. The foundation of these treatment plans are the usual strength and coordination building physical, occupational, and speech therapies. Some patients may benefit from less common therapies, including neurobehavioral therapy, vision therapy, and customizable orthotic braces. Many medical and surgical options exist to treat neurologic conditions. Most patients are candidates for or more of these treatments:
- Nerve stimulators
- Deep brain stimulators
- Powered orthotics
- Alternative mobility devices
- Adaptive utensils and tools
Cancer
Complications of cancer and side effects from the treatment of cancer are extremely common and may lead to subacute care admission. Over 40% of Americans will be diagnosed with cancer at some point in their lives. Due to cancer’s ability to spread, cancer in one organ or area of the body can cause severe and disabling symptoms throughout the entire body. Some of the cancers that most commonly lead to subacute care are:
- Breast cancer
- Lung cancer
- Prostate cancer
- Gastric cancer
- Esophageal cancer
- Uterine cancer
- Brain cancer
The complications of chemotherapy and surgery for the treatment of cancer also often lead to severe disability. Weakness, loss of coordination, chronic pain, and difficulty with common daily tasks are present in many patients with cancer-related complications. Patients with these complications typically only require the traditional occupational, speech, and physical therapy offered to all patients in subacute care.
Even though there are few special therapies or treatments available in subacute care for patients with cancer or cancer-related complications, most patients still see amazing benefits from subacute care. The strength and energy the body gains from the therapies provided in subacute care give patients the tools they need to stay strong during their battle with cancer.
Traumatic Injuries
Patients with traumatic injuries have some of the greatest potential for benefit in subacute care. The body requires weeks to months to recover from a severe traumatic injury. Only a short period of this time can be spent in the hospital, so the additional recovery time, therapy, and medical treatment provided in subacute care are critical to ensuring the best possible recovery.
Some of the traumatic injuries that commonly lead to admission to subacute care are:
- Traumatic brain injury
- Catastrophic injury
- Spinal cord injury
- Solid organ injury
- Intestinal injury
- Skull fracture
- Rib fractures
- Pelvic fracture
- Femoral fracture
Many of these injuries have specialized treatments and therapies that can improve patients’ return to their everyday lives.
- Cognitive therapy: Thought exercises and discussions that help patients identify and correct harmful thoughts, behaviors, and emotional responses.
- Neurobehavioral therapy: Exercises to help subconsciously guide the brain towards more effective processing of thoughts, emotions, and sensory stimuli.
- Vision therapy: Treatments focused on improving the brain’s ability to process visual stimuli and correct changes in vision caused by damage to the nerves, muscles, and other supporting structures of the eyes.
- Vestibular Therapy: Exercises and treatments designed to improve balance and coordination.
Pulmonary Conditions
Pulmonary conditions include those that affect the lungs, chest muscles, ribs, or airways leading from the mouth and nose to the lungs. They can lead to hospital admission or develop after hospital admission for another medical issue. The most common pulmonary conditions that benefit from subacute care are:
- Aspiration
- Pneumonia
- Chronic obstructive pulmonary disease
- Intercostal muscle weakness
- Diaphragm injuries
- Rib fractures
Aspiration, the inhalation of food, drink, or saliva into the lungs, and pneumonia commonly occur after patients are admitted to the hospital due to severe illness that prevents the body from naturally protecting the lungs. Intercostal muscle weakness is a breakdown of the muscles between the ribs that are critical for exhalation. Strength in these muscles can be lost in patients on ventilators. Diaphragm injuries and rib fractures can result from trauma or chest surgery.
Many patients with medical conditions that normally would not require subacute care after hospital discharge may develop one or more of these pulmonary conditions during their admission to the hospital. Even if the condition that led to hospital admission is resolved upon discharge, subacute care may be beneficial for the treatment of complications related to hospitalization.
The most beneficial treatment in subacute care for most pulmonary conditions is respiratory therapy. Respiratory therapists can help strengthen the diaphragm and intercostal muscles necessary for proper respiration. They have multiple medical treatments that can help loosen mucus in the airway and promote natural clearing of the airways that lead into the lungs. Respiratory therapists also maintain the breathing tubes and ventilators that some patients with chronic pulmonary conditions rely on to live.
Liver, Kidney, and Intestinal conditions
Conditions that affect the liver, kidneys, and intestines are commonly referred to as metabolic conditions. These organs are responsible for regulating the balance of fluids, electrolytes, nutrients, and toxins in the body. Metabolic conditions often require the involvement of multiple specialists to treat them safely. Patients with complex metabolic conditions may require subacute care after hospitalization to allow for preparation for an organ transplant, initiation of regularly scheduled outpatient treatments, recovery of muscle mass, strength, coordination, and the skills necessary to manage a potentially complex medical condition at home.
The most common metabolic conditions that lead to subacute care admission are:
- Kidney failure (end-stage renal disease)
- Liver failure
- Malnutrition
- Inflammatory bowel disease
- Intestinal surgery
- Pancreatitis
- Kidney infections (pyelonephritis)
Infections and Sepsis
Similar to pulmonary conditions, infections and sepsis (severe infections that spread throughout the body) can lead to hospital admission or develop after admission as a complication of another medical condition or injury. Severe infections and sepsis can then lead to additional pulmonary, cardiac, neurologic, and metabolic conditions.
Some infections are easily treated with oral antibiotics. Others may require intravenous antibiotics and specialty consultations. Patients in subacute care with infections may have intravenous lines placed for antibiotics and daily blood tests to monitor treatment progress.
The close relationship between infections and the other medical conditions listed here illustrates another major benefit of subacute care. Patients who are still recovering from a medical condition after discharge are at risk of developing other medical conditions that may go undetected if the only post-hospital treatments provided are the typical once or twice monthly doctor’s office and therapy visits. Subacute care allows for early detection of developing complications, reducing the risk a patient will need to be re-admitted to the hospital or experience another life-threatening medical condition.
References
Martin SS, Aday AW, Almarzooq ZI, et. al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation. 2023:149(8). https://www.ahajournals.org/doi/10.1161/CIR.0000000000001209#:~:text=It%20is%20estimated%20that%20roughly,failure%2C%20stroke%2C%20or%20hypertension
National Institutes of Health. Cancer Statistics. Accessed May 22, 2024.
https://www.cancer.gov/about-cancer/understanding/statistics#:~:text=Approximately%2040.5%25%20of%20men%20and,will%20die%20of%20the%20disease.
