Healing from a major injury or medical emergency continues long after you or your loved one leaves the hospital. Time spent in the hospital is known as acute care and is focused on stabilizing life-threatening medical conditions or injuries. In many cases, these life-threatening conditions leave patients with disabilities and medical needs that require ongoing care before they can return to their everyday lives. Subacute care is the next step; it allows for a healthy transition between the hospital and home. This article will discuss what happens after the hospital and what you can expect from subacute care.
Hospitalization
Many conditions can lead to hospital admission. Some are relatively mild and may only require a few days of admission and treatment. Others are much more severe and commonly require ongoing care after hospitalization. Some of the most common conditions that may require subacute care after discharge from the hospital are:
- Cancer
- Stroke
- Heart attack
- Heart failure
- Motor vehicle accidents
- Catastrophic injuries
- Spinal cord injury
- Brain injury
- Fractures
- Liver disease
- Kidney failure
- Autoimmune disorders
- COPD (chronic obstructive pulmonary disease)
Care in the hospital for these conditions will involve more than just doctors. Multiple therapists work with patients on strength, coordination, speech, nutrition, and medication management. However, due to the large number of patients in the hospital, the amount of time they have with any one individual patient is limited. Most patient’s time in the hospital is also short, meaning that their therapies and interventions rarely lead to complete recovery.
At the time of discharge from the hospital, most patients are in a state where they will benefit from subacute care. Hospitals will have referral partnerships in place for specific facilities and insurance providers may have preferred providers of subacute care. Patients and their families can also choose their own subacute care provider.
Basics of Subacute Care
“Subacute care” refers to care that occurs after a hospitalization or major injury/illness that is more frequent, intense, or complex than the usual process of setting individual medical appointments and following up monthly. What subacute care will look like for a patient varies widely based on their needs.
Many types of facilities and groups offer subacute care. Most types of subacute care offer the same basic services, programs, and care. The major differences are if they are attached to a hospital, the types of patients they specialize in caring for, and the level of care their patients require. The most common types of subacute care are:
- Transitional care: An area in a hospital that is dedicated to patients who will be leaving for subacute care. May care for patients who are waiting to be accepted into subacute care or are expected only to require a very short period of subacute care. May have more limited services compared to other subacute care options.
- In-hospital subacute care: Similar to transitional care, but intended to provide for all of a patient’s subacute care needs for an extended period of time.
- Rehabilitation facilities: Subacute care facilities that specialize in rehabilitation. May have a greater focus on therapy than other providers of subacute care.
- Long-term care: Specialized in caring for patients expected to require care indefinitely or for an extended duration. Generally cares for patients who are too medically complex for skilled nursing facilities.
- Skilled nursing facilities: Cares for patients who cannot safely meet their daily needs in a traditional home environment and require regular assistance or supervision.
- Assisted living facilities: Helps care for patients who can spend some or all of their time alone but may need assistance with specific tasks. Technically not a form of subacute care, but many offer services available in subacute care.
Definition of Subacute Care
In its simplest form, subacute care is medical care for patients who no longer need to stay in the hospital to treat a life-threatening medical condition but require more complex daily treatments or therapies to recover from or prevent the return of that condition than can be safely provided at home.
Defining the term “subacute care” is complex both legally and medically. Many patients in subacute care are receiving Medicaid or Medicare payments. Certain levels of medical need must be present in order for a patient to qualify for certain types of subacute care. For more information on this process, read our article on the definitions of subacute care.
Specific Interventions in Subacute Care
While nearly all subacute care offerings are unique, many offer similar treatments and services to patients. These offerings can be grouped into medical care, therapies, assistance with daily activities, and care coordination.
Medical care
All patients in subacute care will require some form of ongoing medical care. This is as simple as daily medications and the occasional follow-up appointment for some patients. Other patients may require multiple specialist visits and repeat procedures.
Some subacute care providers will have multiple medical specialists on site, which minimizes the number of times patients must leave the facility to receive follow-up. Others may have staff trained in the use of specialized medical equipment required during the recovery from certain conditions.
Therapies
Therapy is the foundation of subacute care. Most subacute care providers will have therapists available who specialize in several areas. Unlike therapy in the outpatient setting, therapy in subacute care is often multiple hours a day, leading to much more rapid improvement.
- Physical therapists primarily work with the large muscles of the arms, legs, and trunk. They help patients restore strength, balance, and coordination. They are one of the most commonly available therapists, as one of the most common reasons for subacute care admission is insufficient strength to move around at home safely.
- Occupational therapists focus primarily on the function of the hands and the ability to make fine movements. This is helpful both in the workplace and with nearly all activities inside the home and out in the community. Occupational therapy can help patients return to independent living and a career after a disabling condition or injury.
- Speech therapists assist patients with all types of communication and language. They are also concerned with the motion and strength of the mouth muscles. Making them essential for patients with conditions that impair swallowing, speech, or communication.
- Neurobehavioral therapists specialize in managing changes in thinking ability and behavior that can occur with severe injury or illness. These therapists can be beneficial for almost any patient but are indispensable for patients living with traumatic brain injury, stroke, and dementia.
Assistance With Daily Activities
Many of the small tasks people perform in a day become much more difficult after a major illness or injury. “Activities of daily living” or ADLs include all of the cooking, cleaning, home care, and personal hygiene tasks a person performs daily. If a patient cannot complete these, they cannot return home.
Many of the therapies provided in subacute care are intended to help patients regain the ability to complete these ADLs on their own. Nurses, nurse assistants, dieticians, and cleaning staff assist with many of these ADLs, allowing patients to focus on their healing and recovery instead of finding people to help them survive in their day-to-day lives.
Care Coordination
One of the most challenging aspects of recovering from a new injury or medical condition is the coordination between therapists, medical specialists, medical equipment companies, pharmacies, and insurance companies. A lot of patience, medical knowledge, and time is required to avoid delays in care that can cause medical complications or slowdowns in patients’ recovery.
Nearly all subacute care providers assist with care coordination, but the level of assistance provided can vary significantly between programs. Choosing a program offering comprehensive care coordination services can make the process of receiving subacute care and preparing for the next steps in recovery much smoother.
Discharge from Subacute Care and What Comes Next
Most patients who enter a subacute care program aim to return to their lives outside the healthcare system as quickly as possible. The process of leaving subacute care and transitioning back to the traditional outpatient style of medical care is where the differences between subacute care programs can become most apparent.
A subacute care program that sets its patients up for success will have multiple skilled therapists, multiple medical specialists available to follow patients’ progress, excellent communication between members of the medical team, modern and well-equipped facilities, and a strong care-coordination team. SierraCare is a program with multiple facilities throughout central California with all these services and more available. SierraCare also offers multiple levels of care beyond subacute care, with outpatient therapies, day programs, and follow-up visits available to maximize patient’s success at leaving subacute care and returning to their regular daily lives.
If you or a loved one need subacute care services, including medical specialty care, therapy, care coordination, or have questions about the benefits of subacute care, please contact us today!
