Post-acute networks cover a wide spectrum
Acute care hospital usually drives system
Developing a post-acute continuum begins with identifying the components that exist within a community and gauging each provider’s willingness to participate. A post-acute network may include the following providers:
• Acute care hospital. Most likely, the acute care hospital will be the driver of the system because that facility will have greater access to money, managed care contracts, and patients. The hospital will act as a referral source to post-acute providers along the continuum. In many cases, it will act as the central case manager, working with case managers of the other post-acute providers to move patients along the continuum.
Providing care for 25 days or longer
• Long-term care hospital. This is an acute care licensed facility that serves patients who require an average length of stay of 25 days or longer. These patients usually experience many comorbid or coexisting conditions along with the primary reason for the hospital admission. Patients requiring a long-term hospital stay need daily medical surveillance, 24-hour professional nursing care averaging from seven to 10 hours per patient day, and one to two hours of therapy intervention per day five days a week.
• Subacute care. A facility for less intensive monitoring and assessment than an acute hospital stay, subacute care facilities provide continuous nursing services and more skilled medical services and procedures, such as rehabilitation. The care may occur before, after, or in lieu of an acute rehabilitation stay. Subacute care can be delivered in a hospital-based unit or in a skilled nursing facility.
• Skilled nursing facility. These sites provide skilled nursing care to residents needing continuous nursing, rehabilitative, and other health or social services. The facility may be free-standing or part of a hospital. All Medicare-eligible skilled nursing facilities require a three-day hospital stay within the last 30 days prior to skilled nursing facility admission. Medicare reimbursement pays up to 100 days per episode of illness; however, most nursing home patient days are not paid for by Medicare.
• Assisted living. This a specialized combination of housing, personalized supportive services, and health care services designed to respond to the individual needs of those who require help with activities of daily living but do not need the skilled medical care provided in a nursing home. While many facilities are freestanding, many others are part of retirement communities that include skilled nursing facilities, independent living facilities, and geriatric centers. Health care services can be provided internally or contracted from a health care provider.
• Home health care. These facilities provide complex medical services to homebound patients who do not require an acute facility stay and who may have difficulty obtaining access to outpatient services. Services include nursing services, home health care, personal care, social services, and other ancillary services, as well as home medical equipment, infusion therapy, enteral therapy, and clinical respiratory therapy.
Day care promotes independence
• Adult day care. This kind of site provides programs committed to helping families care for older adults, allowing seniors to continue to live with their families. Day care’s primary emphasis is on promoting independence, self-esteem, and health. Adult day care programs provide needed emotional support and respite for families. Program components include health monitoring, exercise retraining, community outings, group activities, hot lunch, and morning snacks.
• Comprehensive rehabilitation facility. These Medicare-funded facilities are required by the federal government to provide physical therapy, social services, and physician services. Optionally, the facility may also provide occupational therapy, respiratory therapy, and speech therapy. Hospitals sometimes place comprehensive rehabilitation facility within a long-term care facility, which includes hospital-based therapists delivering therapy services.
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