SUB-ACUTE CARE IN GERIATRICS

Jose Leo V. Jiloca, MD

Sub-acute care is an important component of the continuum of care for elderly

persons, and care in this setting is frequently provided by geriatricians and geriatric
nurse practitioners. It is referred to as the care given to patients after admitted or
managed in the acute care setting which is the hospital. Hence the terminologies
postacute care and transitional care also applies either in the free-standing skilled
nursing facilities (SNFs) or in the hospital-based transitional care units.

In the subacute care there is management of discrete episodes of illness

requiring medical management and/or functional rehabilitation. The frequency of
medical encounters and the costs of care are also intermediate between the hospital
and long-term care settings.

Subacute care has filled the need for a place where these patients can receive
ongoing medical and nursing care, in addition to skilled rehabilitation and discharge
planning for eventual return to the community. Length of stay in subacute care varies
widely, from less than 1 week up to 100 days with the average is generally 1 to 3
weeks.

Managed care plans tend to admit sicker patients to SNFs for shorter lengths of
stay, and managed care providers have been the leaders in developing expertise in
subacute care. There are protocols for facilitating hospital transfers, assessing patients,
delivering sophisticated medical care, addressing acute medical problems, minimizing
rehospitalizations, providing case management, and proactive discharge planning.

Subacute patients tend to be younger (average age in seventies rather than late
eighties), more acutely ill, but less likely to have dementia or major chronic functional
limitations. Most patients admitted for subacute care come directly from hospitals and
are expected to return to their homes after a specific, planned treatment course.

The goals of subacute care include maximizing return to the community,

minimizing rehospitalizations and minimizing long-term care placements.