Subacute Rehabilitation- An Overview

What Is Subacute Rehabilitation?

Subacute rehabilitation is medically necessary inpatient rehabilitative care provided to stable patients who do not require acute rehabilitative care. These include patients who require care that is between intensive hospital care and independent living. The goal-oriented interdisciplinary approach in subacute rehabilitation helps successfully treat patients after acute hospitalization.

A customized treatment program is planned for each patient, including different therapy sessions and nursing care. As it is a type of inpatient care, the patient can access the physicians and nurses throughout the program. Subacute rehabilitative care is less intensive when compared to acute care. Subacute rehabilitation programs typically accept elderly patients with diagnoses who do not meet the criteria for independent rehabilitation centers.

What Are the Qualifying Criteria for Subacute Care?

The admission and qualifying stay criteria for subacute care include the following:

• Residential hospital stays for a minimum of three consecutive days.

• The patient should be admitted to the subacute unit within a specified time after acute hospitalization (generally within a month).

• The patient requires one or more rehabilitation programs daily, which should be carried out in an outcome-focused, interdisciplinary manner with a clear discharge plan.

• The services should be reasonable and consistent with the nature and severity of the patient’s condition.

• Professional and skilled nursing care should be provided.

• The physician should make frequent onsite visits.

• The patient should be medically stable.

• The patient should be able to participate actively in less intensive rehabilitation programs. The patient should have satisfying mental status and the ability to respond to simple commands.

• The patient is expected to show measurable functional improvement within two weeks of admission (depending on the patient’s underlying medical condition).

What Are the Different Types of Subacute Care Admissions?

The different types of subacute care admissions are:

1. Short-Term Stay: In a short-term stay, the length ranges between two and three weeks. These types of subacute care are carried out in Subacute Rehabilitation Units (SRU) or advanced subacute rehabilitation centers in hospitals, nursing homes, and free-standing rehabilitation hospitals.

2. Long-Term Stay: The long-term stay lasts for 60 to 100 days. Most subacute rehabilitation is of this type and is carried out in nursing homes. The length of stay depends on the following factors:

• Overall health status of the patient.

• The severity of the medical condition.

• Insurance coverage.

• Ability to live independently after the program.

Who Are the Candidates Requiring Subacute Care?

Subacute care is needed for patients who need treatment for the following conditions:

• Traumatic brain injury.

• Congenital anomalies or inherited medical conditions.

• Neuromuscular disorders - diseases that affect the peripheral nervous system.

• Spinal cord injury.

• Intensive wound care.

• Long-lasting stroke issues.

• Eating disorders, such as binge eating or overeating.

• Cancer.

• GI (gastrointestinal) tube issues.

• Terminal illness in its early stage.

• Lou Gehrig’s disease (a nervous system disorder that causes progressive degeneration of neurons that control muscles, resulting in muscle wasting).

Surgeries including:

• Amputation - Removal or loss of a body part.

• Parkinson’s Disease - a chronic degenerative nervous system disorder that causes problems with balance and coordination.

• Diabetes - High blood sugar.

• Respiratory Disease - Such as asthma- breathing difficulty due to inflammation, swelling, and narrowing.

• Congestive Heart Failure - A condition in which the heart is unable to pump blood.

• Peripheral Vascular Disease - A disease that causes a reduction in blood flow to the limbs due to narrowing of the blood vessels.

• Joint replacement surgery.

• Heart surgery.

• Brain surgery.

What Things Need to Be Considered While Choosing an Advanced Sub-Acute Rehabilitation Center?

The following are the things that need to be considered while choosing an advanced subacute rehabilitation center:

• The Experience of the Faculties: The faculties should be certified and have adequate experience treating the health condition. Data that reveals the quality of care should be provided. Choosing a facility that aims for community benefits rather than only patient needs is more beneficial.

• Skilled Nurses Availability: A skilled nurse, beyond assisting, also tracks health status, cleans wounds, and monitors tube feeding. Choosing a facility with a good number of skilled nurses is always advisable.

• Multidisciplinary Team of Specialists: Neuro-orthopedic, cardiac, respiratory, and other health conditions can significantly affect mobility, day-to-day activities, and independence. Subacute rehabilitation, guided by a multidisciplinary team of specialists, helps one achieve independence. Choosing a facility that has a multidisciplinary specialist team will speed post-hospital recovery.

• The Level of Program Customization: A good rehabilitation facility considers each individual’s health needs.

What Is the Difference Between Acute and Subacute Rehabilitation?

Acute care rehabilitation is intensive rehabilitation for individuals who have had acute care surgery or suffered from a debilitating disease. Individuals who undergo acute care rehabilitation may have any of the following conditions:

• Debilitating respiratory disease like COPD (Chronic Obstructive Pulmonary Disease).

• Heart attack.

• Stroke (minimal) - Blood supply interruption causing damage to the brain.

• Surgeries.

• Pneumonia - Inflammation due to infection in the air sacs of the lungs.

Acute rehabilitation care has the following characteristics;

• Therapy sessions are more intensive and last three hours or more daily.

• The therapy sessions are conducted for a minimum of five days a week.

• A multidisciplinary healthcare team ensures the patient can do day-to-day activities.

• The patient undergoes occupational, physical, and speech therapy as required.

• The patient receives a face-to-face assessment.

On the other hand, subacute care is the best option for someone who has undergone acute rehabilitation but still requires some therapy to regain full functionality.

The characteristics of subacute care include the following:

• It is less intensive than acute rehabilitation and lasts two hours or less daily.

• Sessions involve a combination of speech, physical, and occupational therapy.

• Focuses on improving strength and mobility and, in the short and long-term, functionality of the patient.

• Frequent meetings are conducted between patients, family members, and the healthcare team to achieve the goals.

What Are All Therapy Sessions Included in Subacute Care?

At first, a thorough medical evaluation of the patient is conducted. A case manager oversees the patient’s treatment. Subacute care involves the following:

1. Nursing Care: Nursing care is given several times a day and includes the following:

• Ventilator programs.

• Wound care.

• Pain management.

• Infusion therapy.

• Intravenous feeding.

2. Therapy Sessions: Depending upon the individual's requirements, the following therapy sessions are available:

• Physical Therapy or physiotherapy.

• Occupational Therapy - Treating old-age patients by developing meaningful occupations and activities.

• Nutritional Therapy - Involving patients in new health goals by using healthy diets, foods, and supplements.

• Art Therapy - It is a therapy that involves creative ways of expressing visuals and thoughts to treat a patient’s mental health.

• Speech Therapy - It involves diagnosing and treating speech disorders in patients of all age groups.

• Recreational Therapy - Involves the patient's physical and psychological health is taken care of by utilizing various reactional and other activities as per their individual assessed needs.

• Psychosocial Therapy - Involves talk therapy and social and vocational training to treat patients’ mental health illnesses.

3. Auxiliary Services:

Supplementary services like pharmacy, labs, medical equipment, and prosthetic services are also provided. Social workers and case managers also provide additional support.

Conclusion

Subacute rehabilitative care or advanced subacute rehabilitation centers are provided to those patients who do not require intensive hospital care but still require therapy to improve their functionality. The sessions are less intensive than acute care and may be short-stay or long-stay. Skilled nurses and therapy specialists carry out the sessions and aim to improve the individual's overall functionality.