Transitions of Care: Navigating the Post-Acute Care Landscape, Part 1
Discover what happens after patients are release from acute care hospital in this two-part series. Learn about options and the type of facilites that fall under the post-acute care unbrella.
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Every year millions of Americans are admitted to and discharged from acute care hospitals across the nation. According to the Centers for Medicare & Medicaid Services (CMS), acute care hospitals are facilities that provide inpatient medical care and other related services for surgery, acute medical conditions or injuries that are usually for a short-term illness or condition. Once the short-term illness or condition resolves, patients are discharged from acute care hospitals. Where they go during the post-acute care phase depends on the nature of the illness. In Part 1 of this article, we will explore the different destination options for patients leaving an acute care hospital.
The first thing to take into account is the location where patients can safely receive medical care. Some patients will need to receive medical care while living at a medical facility whereas others will be able to return home with outpatient services. There are different levels of care for inpatient facilities in the post-acute care period.
The highest level of care would be at a long-term acute care hospital (LTACH). LTACHs are hospitals with around-the-clock nursing care, daily physician visits, physical therapy, occupational therapy and speech therapy, among others. Some of the more common illnesses necessitating continued care include respiratory failure requiring assistance of a ventilator or high amounts of oxygen, severe bacterial infections requiring prolonged IV antibiotics, and complex wounds requiring inpatient wound care. These hospitals are similar to acute care hospitals in that they provide intensive care unit-level care, and step-down unit care along with care in a medical ward.
Another destination in the post-acute care period is an inpatient rehabilitation facility. According to CMS, these facilities provide an intensive rehabilitation program consisting of three hours of intensive rehabilitation services per day. The acute illness for the most part has resolved at this point which allows patients to participate in daily rehab. Some rehabilitation facilities are free-standing hospitals while others are a part of a hospital. These facilities are different from drug and alcohol treatment facilities.
Skilled nursing facilities are treatment centers where patients can continue to receive occupational, physical and speech therapy. Patients at this level of care do not require daily physician visits or laboratory studies. Their acute illness has significantly improved but there may be a few medical needs that cannot be met in an outpatient setting.
Patients who can safely be discharged home may still require medical care. That can be delivered in many different ways. Some patients have home health service including wound care for pressure sores or surgical wounds, intravenous therapy, and assistance with nutrition via a feeding tube, to name a few. These patients are stable enough to not require daily nursing and medical care. Patients may also receive outpatient physical, occupational and speech therapy.
This is a glimpse into the complexity of the post-acute care environment. Communication with your medical team
is key. Involve a family member or a trusted friend to help you navigate through this system. This is especially important for people who may have lost the ability to communicate and express their wishes.
Dr. Gabriel Vidal is a board-certified internist who is currently pursuing further training in oncology at the Stephenson Cancer Center at University of Oklahoma Health Sciences Center.