Beyond the Hospital: Understanding Post-Acute Care Options

I. WHAT IS POST-ACUTE CARE?

A. Post-acute care, what does that mean? For many patients experiencing a life-altering illness or injury, you will face a decision on what your next steps in the recovery process should be. Post-acute care means that you are being discharged from a hospital and you need care to be provided after your acute or inpatient hospital care is completed. You may still have medical needs that will require continued monitoring by a nurse or physician. You may also have physical needs that will require therapy services such as physical, occupational or speech therapy. These needs, depending on their severity, can be met at several different levels, including, sometimes in the comfort of your own home. So, the next question is how do you know which level is right for you? This article supplies options that you can explore with your healthcare provider. The following sections outline the most common post-acute care options and who may benefit from each.

II. MEDICAL REHABILITATION HOSPITALS

A. Medical rehabilitation hospitals, which are licensed and accredited, provide post-acute care with an emphasis on therapy. Care at medical rehabilitation hospitals is physician-led and takes an interdisciplinary approach to your post-acute needs, which includes 24/7 rehabilitative nursing; physical, occupational and/or speech therapies; and other specialized services as needed. Custom treatment plans are created to address your individual needs. Medical rehabilitation hospitals are known for the intensive therapy that is offered over a short length of stay, typically 10-14 days. You can expect to complete therapy 5 days per week for around 3 hours each day depending on patient tolerance. The therapy sessions can be divided up and spaced throughout the day to ensure you are able to rest in between therapy sessions. Healthcare professionals at medical rehabilitation hospitals have many capabilities such as the ability to administer IV antibiotics or fluids, check lab work, and obtain radiology on a smaller scale than the acute care hospitals. Patients who benefit the most from this type of hospital stay are the patients who are medically stable, motivated to get better quickly and can meet the requirement of 3 hour per day therapy minimums. A national study shows that patients treated at medical rehabilitation hospitals return home sooner, remain home longer, have fewer hospital readmissions and ER visits, and live longer.

III. SKILLED NURSING FACILITIES

A. If intensive rehabilitation is not appropriate, a skilled nursing facility (SNF) may be the next best post-acute care option. At times, patients will need to work within a less intense therapy program before they are able to benefit from a medical rehabilitation hospital stay or return home. In a SNF, a patient will be offered therapy 1-2 hours per day/3-5 days per week. This setting is ideal for patients who cannot tolerate intense therapy but still need medical oversight prior to returning home. Most skilled facilities can assist with IV antibiotics and wound care needs. Similar to a medical rehabilitation hospital, a SNF can also obtain basic labs or radiology results when needed. Coverage and length of stay will vary by insurance plan; many plans cover short-term stays of up to 20 days. If you are interested in this option, you can contact your local facilities to schedule a tour and learn more about the services they offer.

IV. HOME HEALTH CARE

A. For patients who are doing well at discharge from the acute care hospital but would benefit from additional therapy at home, home health care may be the best option. To qualify for home health, a patient generally must meet homebound criteria. To be considered homebound, it would be
recommended that you not leave your home due to your condition. It also may be indicated if it takes you significant effort to leave your home with or without assistance. Home health care companies will work with your insurance to send physical, occupational or speech therapists to your home to work with you. They can also send out a skilled nurse to assist with basic wound care and medication management, a medical social worker to address any resources you may need and in some cases a home health aide to help with bathing 1-2 times per week. Home health care benefits vary drastically between insurance providers. If you are considering this option, it is important to call your insurance plan to see what services they will cover as well as how often you will be able to receive each service. In some cases, home health is covered at 100% by the insurance plan and at other times you may have a co-pay. This is a good choice for patients who are ready to go home but still require some assistance to get back to their prior level of function.

V. OUTPATIENT THERAPY SERVICES

A. For patients who do not meet the homebound requirements, another option to get home would be outpatient therapy services. Outpatient therapy services can be provided for your physical, occupational and speech therapy needs. These services can be arranged prior to discharging home from the acute care hospital or even after a stay in a medical rehabilitation hospital or SNF. These services are performed in a gym-like setting and would be scheduled for 1-2 times per week. In this situation, a patient will need a ride to these appointments and can expect the sessions to be approximately 30 minutes to 1 hour in length. The care team at the outpatient clinic will also provide patients with exercises to perform at home, in between sessions. This choice would be best for a patient with therapy needs that is medically stable and has access to transportation to the appointments.

VI. CONCLUSION

A. Understanding your post-acute care alternatives can make the transition from hospital to home less overwhelming. By working with your care team and exploring available resources, you can choose the setting that best supports your recovery and long-term independence. Case managers in the facilities will help to arrange these after-care services and can aid you in making the best decision for you and your loved ones. Another great resource is Medicare.gov, this website can help you to review your post- acute care options and has sections to explain each one in more detail. It pulls objective data from different facilities and companies to help in choosing the option that best suits your needs. You have a choice in your healthcare and many options that help to ensure you get the assistance you need to return home safely.