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Subacute care is inpatient care for people with an acute illness, injury, or those experiencing the exacerbation of a disease. Due to the intensive nature and high level of care needed in subacute care, it is administered by licensed nurses with specialized training. To qualify for subacute care, seniors often need additional help to manage new or changing health conditions. 

Seniors who have received acute care and treatment but still require therapy may look to subacute care facilities. Many Skilled Nursing Facilities (SNFs), skilled nursing units, or rehabilitation hospitals will have subacute units. It is worth noting that there is no distinct Medicare payment for subacute care when it is provided by a SNF.

The Differences Between Acute vs. Subacute Care

It is worthwhile comparing acute vs. subacute to better understand how they overlap and where they differ. According to Knollwood Nursing Center, acute care is classified as intensive rehabilitation for seniors who have recently had surgery or previously suffered from a debilitating illness or injury. Therefore, when comparing acute vs. subacute, it is worth noting the following differences:

The Nature of Rehabilitation

Rehab in an acute care setting is intensive and consists of:

  • Therapy for three hours or more per day
  • Therapy for five days or more per week
  • Daily face-to-face assessments with updated therapy plans recorded in care plan software
  • A combination of physical, occupational, and speech therapy as needed
  • A multidisciplinary approach with the purpose of ensuring that the patient can return to their daily life
Nurse providing physical therapy to a patient in subacute care
Subacute care typically consists of therapy that is two hours or less.

Subacute care, on the other hand, is less intensive. Typical subacute therapy usually consists of:

  • Shorter sessions, two hours or less with resident records stored in a long term care EHR  
  • Focused sessions on strength, mobility, and long term functionality
  • A combination of physical, occupational, and speech therapy
  • Frequent meetings with the resident and their family to ensure everyone’s goals are aligned

Who Qualifies for Care

Individuals who qualify for acute care have often suffered:

  • A heart attack
  • A stroke
  • Pneumonia
  • COPD or a similarly debilitating illness
  • A difficult recovery following surgery

As for subacute care,  residents in long term care facilities are typically given treatment for the following:

  • ALS, cancer, and other terminal illnesses in their early stages
  • Eating disorders
  • Malnutrition
  • Spinal cord injury (SCI)
  • Neuromuscular disorders
  • Congenital anomalies
  • Intensive wound care
  • IV treatments
  • GI tube issues
  • Major, long-lasting stroke issues

The Care Included

Elderly sick patient lying in bed
Acute care encompasses a range of clinical healthcare functions, including critical care.

A study published by The Bulletin of the World Health Organization notes that acute care encompasses a range of clinical healthcare functions that include:

  • Emergency Medicine
  • Trauma Care
  • Pre-hospital emergency care
  • Acute care surgery
  • Critical Care
  • Urgent Care and
  • Short-term inpatient stabilization

Subacute care, on the other hand, consists of special services such as:

  • Inhalation therapy
  • Tracheotomy care
  • Intravenous tube feeding 
  • Complex wound management and care

The Goals of Care Provided

The goal of acute care is to rapidly treat, stabilize, and transfer patients to long-term rehab when appropriate. Meanwhile, the goal of subacute care, is to provide support to a resident so they regain the ability to carry out activities of daily living (ADLs) following an illness or help them with managing new changes to their health conditions.

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11 Things to Know About Subacute Rehab 

Subacute rehab—also called subacute rehabilitation or SAR—is typically provided in a licensed Skilled Nursing Facility (SNF) to a resident suffering from an illness or injury. Below are 11 things that Very Well Health suggests families familiarize themselves with before deciding to move a loved one to subacute care: 

Physical therapist performing physical therapy for adult patient.
Residents who have experienced a fall, an injury, or have a pre-existing medical condition may benefit from subacute rehabilitation.
  1. Services Provided: Families researching acute vs. subacute care need to determine what services are provided, such as tracheotomy care and complex wound management and care.
  2. Medicare Coverage: Subacute rehab is typically paid for by Medicare or a Medicare Advantage Program. Hence, seniors and their families should check their eligibility.
  3. Beneficiaries of Subacute Rehab: Residents who have experienced a fall, an injury, or have a pre-existing medical condition may benefit from subacute rehabilitation. 
  4. Therapy: Therapy is usually based on recommendations given by a resident’s physical, occupational, or speech therapist. Therapy sessions in subacute care are less intense than those in acute care. Therefore, families need to check if the appropriate therapy services are provided.
  5. Length of Stay: If we compare the acute vs. subacute time frame, acute care has an average length of stay of approximately thirty days. Whereas, subacute care can vary from a few days to a few weeks. Knollwood Nursing places the average length of stay at a subacute nursing home to be ten to eleven days for seniors.
  6. What Sets Subacute Care Programs Apart From Each Other: For those who are unsure about how to select a nursing home with subacute care services, the Centers for Medicare and Medicaid (CMS) provides a 5-star rating system to ease the selection process. The higher the number of stars given to a facility, the more compliant the facility and the better its services are likely to be.
  7. The Option to Leave Early: For the best care results, residents are advised to listen to their physician. However, if a resident wants to quit their subacute care program and return home before their treatment is complete—against the advice of their physician and therapist—they have every right to do so. Of course, they are also required to sign a leaving against medical advice (AMA) form before leaving.
  8. Insurance Coverage: Insurance companies tend to carefully monitor the services provided in subacute rehab. Suppose a private health insurer refuses to cover subacute care. In that case, the alternative is to talk to a financial adviser and seek Medicare coverage.      
  9. Appealing a Denial Notice: If a resident’s insurance provider ends their subacute rehab coverage, they will typically receive a “cut letter” or a “denial notice.” Those who want to continue their subacute care stay can appeal the decision by following the instructions in the denial notice.
  10. Alternatives to Going Back Home: Sometimes, despite the best effort of physicians and therapists, residents may not regain the ability to function independently at home. In such circumstances, the subacute rehab social worker can look for alternative living options in assisted living, a skilled nursing facility, or a nursing home.
  11. Arranging for Help at Home: Before leaving a subacute rehab facility, residents should ask for referrals and make arrangements for home health services. This is in the event that they still need assistance when they return home.

The Importance of Subacute Care

Subacute care is renowned for its effectiveness in treating specialized medical issues. Residents in subacute care are generally considered medically stable, but they still require some assistance due to frailty or other physical or psychological limitations. Some may require as little as two weeks, while others may require a month or two. This can impose a financial burden on seniors, which is why, before deciding to move to subacute care, one should consult a financial adviser.

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Elijah Oling Wanga