Patient Care Settings Flashcards
Levels of Care
Intensive Care Unit (ICU)
Acute Care Unit (ACU) = Hospital, Medical Center
Acute Rehabilitation Facility (ARF)
Inpatient Rehabilitation Facility (IRF)
Sub-Acute Rehabilitation Facility (Sub-acute)
Skilled Nursing Facility (SNF)
Long-Term Acute Care (LTACH)
Home with Home Health
Home with Outpatient
Home
Intensive Care Unit
Life-threatening injuries and illnesses
Team of specially-trained health care providers ➔ 24 hour care
Function and Mobility in the ICU
Acute Rehabilitation & Inpatient Rehabilitation
Inpatient facility (Fanny Allen)
patient requires and is able to tolerate and participate in a comprehensive level of rehabilitation services
(3 hours minimum of rehab)
requires close rehabilitation medical supervision and available 24- hour daily medical attention
Necessary services cannot be provided in an alternative, less costly, setting
Cannot access necessary care outside a comprehensive rehabilitation setting.
ARF & IRF
Interdisciplinary specialized care
Physiatrist or equivalent > 3days/week, available 24/7 for emergencies
24 hour rehabilitation nursing care
Need for > 2 disciplines PT/OT/SLP
Must also have SW, psychology, rec tx, access to voc rehab, prosthetics/orthotics
ARF Therapy Requirements
Tolerate > 3 hours PT/OT/SLP 5 days/week or 15 hours/week
Need at least 2 disciplines
Benefit from > 3hours of therapy (active participation)
Measurable improvement
ARF D/C
Intended as a relatively brief start to rehab
LOS typically 5-30 days
Expected discharge: SNF or Home
IRF D/C
Intended as a longer stay then ARF
LOS typically 2 weeks - 2 months
Expected DC: SNF or Home
ARF & IRF - Advantages
Inter-disciplinary team
Specialized care
Focus on community re-entry
Availability of hospital services
Capitated reimbursement encourages short LOS
ARF & IRF - Disadvantages
Cost $$$$$
Too fast-paced for many patients
Hospital-based (not home)
Long Term Acute Care Hospital (LTACH)
Chronic Hospital
Patients need acute care services long-term
> 28 days average length of stay
Often used for ventilator care, wound care, TBI (esp. coma stim)
Subacute/Skilled Nursing Facility
Can be in a hospital transitional care unit (TCU) or in a skilled nursing facility (SNF)
Need skilled nursing or therapy
Covered for 100 days maximum Medicare
Subacute/SNF
Paid per diem—incentive to keep patients longer
Typically 1-2 hours PT/OT/SLP daily
Often 1-2 RN/shift + CNAs
Subacute rehab - Advantages
Cost ¢¢
Can stay longer if needed
Option for residence post-discharge
Subacute rehab - Disadvantages
Long LOS
Less therapy
Limited RN
Limited physician visits
Away from hospital services (unless TCU)
NH environment
High rehospitalization rates
Home care
Must be unable to leave home for rehab services ➔ strict criteria
Medicare pays capitated rate
Typically 2-3 x/week visits
Limited home health aide coverage (typically 5-10 hours/week)
