Subacute Care in Long-Term Care Settings

February 1, 2014 | Health System Risk Management


Compared with long-term residents, short-stay patients generally have higher acuity. See Table. Major Diagnostic Classifications Accounting for the Largest Percentage of Medicare Admissions to Skilled Nursing Facilities, 2011 for a list of the most common diagnostic categories for Medicare admissions to skilled nursing. Short-stay patients are often recuperating from a hospital stay and an acute condition, such as a stroke, or a procedure, such as bypass surgery or joint replacement. They may also have comorbidities, and some short-stay patients are older adults.

Thus, short-stay patients may need closer monitoring, quicker recognition of problems, and earlier intervention. If, for example, the patient experiences an unrecognized postsurgical complication or a change in condition is missed, the patient may face the potential for severe harm.

As little as a few days before their admission to the aging services organization, short-stay patients may have been at home, not expecting to shortly be in a skilled nursing facility. They may be unfamiliar with aging services settings, and they may have unrealistic ideas about their condition and rehabilitation goals. Patients who are younger than the long-term care population, in particular, may have unrealistic expectations and be uncomfortable in aging services settings, especially when asked to room with an older resident.

These unrealistic expectations can pose safety risks. Patients may have poor safety awareness, want to prove they can be independent, or be uncomfortable accepting help with activities of daily living such as transfers, ambulation, and toileting. As a result, they may engage in unsafe behaviors. For example, a knee replacement patient might try to stand by herself when she has been told to use the call button and wait for help. Patients may also feel like they are receiving mixed signals if, for example, rehabilitation therapy tells them they will go home as soon as they are independent with transfers and ambulation but nursing instructs them to always use the call bell.

For the organization, subacute care is a different paradigm. Because of the unique needs of short-stay patients, organizational systems and processes that work for the care of long-term residents might not be optimal for the care of short-stay patients. In addition, nurses who are used to caring for long-term residents might lack skills necessary for subacute care or might not have used them in a while. Short-stay patients may need more proactive monitoring, possibly requiring a...

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