As your loved one is bounced around from one care facility to the next, the terminology, levels of care, and procedures for each place can get confusing. The care options swirl in your head as you tentatively try to make the right choices for your loved one. If he or she has been staying in a hospital due to an illness or injury, it is possible that the next step could be admission to a post-acute care provider. This happens when your loved one is still recovering, yet not well enough to return home. In this article, we will discuss what post-acute care is, common providers that practice this type of care, the growth of this industry, and some benefits of post-acute care. First, let’s dive deep into what the terminology refers to.
Post-acute care is a transitional type of care that involves rehabilitation, recuperation, symptom management, and continued medical treatment received after receiving acute care. While the staff may assist your loved one with activities of daily living (ADLs), the primary purpose is recovery after an injury, surgery, or illness. The ultimate goal of post-acute care is to return the patient to wellness and independence. Post-acute care can be provided in a facility, as ongoing outpatient therapy, or as home care. Care services are temporary, ranging from intensive short-term rehab to longer-term restorative care. Post-acute care can last anywhere from a few days to several months. Living at the facility indefinitely is not an option.
As mentioned before, the post-acute care is received after the patient has undergone acute care. So what is the difference between acute and post-acute care? Acute care is a branch of health care where the patient receives active, short-term treatment for an injury, illness, surgery, or other urgent medical condition. Acute care is the opposite of long-term care. It can be applied in the ER of a hospital, surgery center, urgent care, or another short-term care facility. Following acute care, the patient may not be ready to go home, but cannot stay in the hospital. Thus, the reason they enter post-acute care. It is not as urgent as acute care, but still necessary in the recovery process.
During the process of receiving post-acute care, many patients will either undergo a full recovery or learn to manage their chronic illness. Some common conditions that often receive post-acute care include patients in recovery from cardiac or pulmonary disease, stroke or neurological disorders, or orthopedic surgeries. This is because these conditions require rehabilitative therapies between the hospital stay and going home. Other patients have been profoundly affected by accidents, aging, or chronic illnesses. Unlike nursing homes and many other long-term care facilities, post-acute care is for patients of all ages. Although it is more common for older patients to require this type of care, young patients are also in need of intense rehabilitation and monitoring as they recover.
During their stay or term of post-acute care, patients typically receive physical and occupational rehabilitative therapy every day. This can even occur multiple times a day, depending on the severity of his or her condition. Patients are monitored by one or more doctors, a team of nurses, and therapists to ensure their recovery progression. Skilled nurses are on duty 24-hours a day, ensuring your loved one receives the help they need any time of day or night.
Having a full extent of knowledge of the different healthcare systems will help in your decision for what is best for your loved one. With so many different kinds of healthcare facilities out there, it is easy to confuse what kind of facilities offer what type of care and services. Next, we will go over some of the facilities in which post-acute care may be received. This will help clear up any common misconceptions or confusion you may have. Some of the places your loved one may receive post-acute care include:
Long-Term Care Hospitals (LTCHs): Also known as a long-term acute care hospital, or LTACH, this care facility is similar to an ICU in that it provides care to patients receiving prolonged ventilation. These patients require extended hospitalization and provide a higher level of care than a skilled nursing facility or nursing home. Common patients suffer from tuberculosis, complex wound care or burn care, severed brain injuries, respiratory therapy, ventilator weaning, or a chronic disease. Those patients who need intravenous medications or fluids, or require a feeding tube will probably stay at a LTACH. LTACHs came into existence due to Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999. LTACHs are said to house patients for longer than 25 days. These individuals have clinically complex problems that need hospital-level care for extended periods.
Inpatient Rehabilitation Facilities (IRF): IRFs provide intense therapeutic rehabilitative care for those regaining their function after an injury or illness. These patients receive daily therapy of at least three hours, and five days a week. Care at a rehabilitation center is managed by a team composed of doctors, nurses, and therapists. Common patients at an IRF include those who have suffered brain injuries, strokes, other neurological disorders, multiple joint replacements, and fractures to lower extremities or pelvis. Inpatient rehabilitation hospitals strive to offer tailored strategies that help the patient to become independent again and to return home. They want to prevent readmissions. Some patients, however, may need a higher level of care than can be offered at an IRF.
Skilled Nursing Facilities (SNF): A SNF is another common pitstop after being discharged from the hospital. It is best for patients who do not need a high level of care, such as at a LTACH, although they still require medical care and support. The staff at a skilled nursing facility not only provides help with activities of daily living, or ADLs, they provide specific medical care in response to health conditions or injuries. Patients commonly admitted to SNFs are those who have suffered heart attacks or shock, hip or femur fractures or surgeries, joint replacements, sepsis, and kidney and urinary infections. Patients can remain at the facility as long as needed, however, the average length of stay is about four weeks. A patient will receive at least one hour of therapy a day. Doctors are on staff, but nurses provide most of the daily care. Skilled nursing care is paid for by Medicare Part A for up to 100 days.
Home Health Agencies: Home health agencies are also considered part of the post-acute care landscape. Medicare offers a home health benefit that covers skilled nursing and therapy services to patients in their own homes. The patient can receive care under a care plan established by their doctor. They must be homebound and require skilled services on an intermittent basis. This type of care is received after an acute care hospital stay and may need rehabilitation therapy services from a highly-skilled nurse, physical therapist, occupational therapist, speech-language pathologist, or medical social worker. Home health aides are also provided if personal care support is needed. These days in-home health care is made even easier with the ability of mobile monitoring and wearable technologies.
So how can you find the right post-acute care provider for your loved one’s needs? Think about what exactly your loved one needs to make a full recovery. Consult a doctor to help choose which option may be best. Research the facilities available, and find out what kind of experience they have, how quickly patients recover on average, and how they will help you and your loved one with your goals. Here are some other factors to consider:
The Complexity of Medical Care: You may have noticed that the LTACHs have the most complex, intensive care available, as opposed to SNFs, IRFs, and home health caregivers. Therefore patients who need this type of care should choose a LTACH. However, if only moderate care is necessary, SNFs or IRFs are good options. Home health care is probably best for lower-level care than the other 3 options, due to the lack of complex medical equipment available.
Level of Therapy Offered: IRFs are the best option for specific therapies as well as intensive rehab programs to restore independence. LTACHs do offer therapies and rehab programs, but these are not the main focus of these facilities. SNFs also offer such services, but at a lower level. Keep in mind that IRFs require at least three hours of physical therapy or rehab a day, so if your loved one is not willing to commit that amount of time, one of these other options might be a better choice.
Staffing: LTACHs have an array of in-house doctors. Patients in a LTACH can see a doctor at least once a day. IRFs and SNFs also have doctors, but nurses and therapists do most of the daily care. Home health care staffing can include registered nurses (RNs), Licensed Vocational or Practical Nurses (LVN, LPNs), personal care aides (PCAs), home health aides (HHAs), physical therapists (PTs), occupational therapists (OTs), speech-language pathologists (STs), and medical social workers (MSWs).
Costs: LTACHs are the most expensive. SNFs are more cost-effective if the patient does not have complex needs. It is necessary to be familiar with Medicare and Medicaid and their coverages. Medicaid tends to cover long-term nursing home care. Payers like private insurance programs, Medicare, and sometimes Medicaid can help with SNF expenses. Medicare payment for inpatient rehab will extend for 100 days of treatment in each benefit period. However, you have to have been in a hospital for at least three days before the rehab treatment. The benefit period starts when you go into the hospital, and ends when you have not received any care in the hospital or skilled nursing care for 60 days.
These days, the post-acute care industry is booming in our healthcare system. Nearly 40 percent of Medicare beneficiaries receive post-acute care services after leaving the hospital. That totaled $60 billion in 2015 alone. How caused this boom in post-acute care to occur? The Affordable Care Act, Medicare, and insurance companies have something to do with it. The Affordable Care Act has increased the incentives for acute care systems to work closely with post-acute providers, while Medicare and health insurance companies have been shifting more of the risk to hospitals. Many insurance companies no longer pay for readmissions within a certain time after the patients have been discharged. So, if a patient gets discharged, and then returns to the hospital not long after for the same issue or a related one, the hospital will have to absorb the cost and take responsibility. This has affected the improvement of patient care in hospitals and ensuring that the hospital staff will focus on addressing all possible issues of the patient. The patient will then be treated to the best of their ability, drastically reducing the possibility for his or her readmission. Here are some of the financial incentives for hospitals to align with post-acute providers:
For these reasons, hospitals are now taking an extra step to ensure patient recovery through a continuum of care. They have begun to develop partnerships with post-acute care facilities. Patients who no longer need acute care health services at the hospital will be discharged to a post-acute care setting. This will enable them to continue to receive proper care while they recover.
Due to this newfound cooperation between hospitals and post-acute care providers, the post-acute care continuum is exploding in growth. The crowds in these facilities are not only due to this growing movement, but also due to the aging population, rising healthcare costs, and the uptick in chronic disease. And this growth curve is projected to continue.
The high demand for post-acute care has caused a growth in hospice care, skilled nursing facilities, as well as services like care coordination and medical transportation. Home care is also developing due to advances in technological innovation in service delivery as well as quality control.
Post-acute care has many advantages to those who have come from a hospital setting. We will now discuss some of the benefits the patient will receive in this transition period.
Less Likely to Be Readmitted to the Hospital: While in post-acute care, your loved one will be closely monitored for complications or changes in their condition. As a result, the likelihood of catching a new or recurring problem early is high. And they will be able to get the problem cared for on an outpatient basis, outside of an acute care setting.
Primary Care Professionals at Your Disposal: Unlike a busy hospital, post-acute care facilities do not have doctors running around frantically. Experienced professionals are always available to answer your questions and assist with any challenging tasks.
More Home-Like and Comfortable: Some care centers offer a variety of activities and fun social events to participate in. There are also excursions which promote socialization and mental well being. Some activities can include crafts, sensory activities, puzzles, coloring, reading time, musical performances, church services, bingo, cards, books on tape, as well as community outings.
Customized Treatment Plans: Doctors tailor the care plans to your specific needs, which ensures the shortest recovery time possible. Having a focused plan personalized for your loved one proves a remarkable quality of care. The patient-centered approach is applied in the most appropriate setting by using evidence-based guidelines to determine the level of care, as well as the most appropriate site of care. Their goal is to transition the patient to their home promptly.
Improved Outcomes: Data suggests that patients who were treated in post-acute facilities do better than a traditional nursing facility. These patients tended to live longer, spend more days at home, and fewer days in healthcare facilities. They also have fewer emergency room visits. Another analysis indicated that in-home post-acute care is a good option for stronger, healthier patients, and would lead to fewer re-hospitalizations. Stroke victims especially benefit from post-acute care, showing a huge increase in functional recovery enhancement, as well as increased independence in ADLs.
On this long and bumpy road to recovery, post-acute care is a pitstop on your loved one’s health journey. Post-acute care professionals listen to your loved one’s needs, are there 24 hours a day, and enact a customized care plan that will ensure the quickest recovery. The goal is focused on your loved one’s independence, allowing them to get back on the road of life. In this article, we have outlined everything you need to know about post-acute care. We here at CareAsOne hope that you have learned a bit more about the healthcare industry, and what post-acute care can do for your loved one. All the best.