Healthcare Recovery Planning

It used to be fairly simple; people got sick and went into the hospital where they were treated, recovered and went home. People didn’t always recover quickly and they might spend weeks or months in the hospital.  Things have changed radically – nowadays people go into the hospital for a short period of time, become stable and are often discharged to other facilities to continue their recovery, with the goal of returning home to independent living.

Besides the shorter length of stay in an acute hospital, another noticeable difference is that patients are often moved around the hospital quite a bit. The care no longer “follows the patient; the patient follows the care” which means that each nursing unit provides a specific type of specialty care and the patient will be moved to a different unit as his medical needs change. For example, a patient with a broken hip will be admitted to the Surgical Floor. After surgery, he might be admitted to the Intensive Care Unit for a day or two. When he no longer needs to be monitored in the ICU, he’ll be sent to the Medical Floor where he’ll start to receive therapies; after he’s stable he’ll be discharged from the hospital.  It can be disconcerting for a patient to be moved around in such a manner, but this is the most efficient use of the nursing staff for the larger hospitals.

The average length of stay in an acute care hospital is fairly short term; when the senior is considered to be in stable condition he’ll be discharged to another setting. Depending upon the care that the patient requires, he might be sent to another facility or may be discharge directly home. There are several options for care after the discharge from the acute care hospital, and patients are rarely given the opportunity to choose which level they’ll receive. This decision is usually decided by their ability to participate in physical, occupational and speech therapies as well as their specific healthcare needs.

Long-Term Acute Care Hospitals (LTAC)

The most medically complex patients, such as those who are on a ventilator, might not able to go to an acute rehabilitation or skilled nursing facility due to their needing physicians on-site 24 hours a day. Regular acute hospitals aren’t able to hold these patients for months, so they’re sent to an LTAC where the care is cheaper. This is because LTAC’s don’t offer specialty services such as maternity wards, emergency rooms, etc, so they are able to offer the same care as the acute hospital for a longer period of time at a lesser cost. Patients receive physical, occupational and speech therapies while they’re in LTAC’s, just the same as if they’re in the acute care hospital, and Medicare, Medicaid and private insurance policies pay for this level of care in the same manner that they pay for acute care hospitals.

Acute Rehabilitation Facilities

Acute rehabilitation is an excellent option for the patient who is ready to be discharged from the hospital, requires 24-hour care and is able to participate in therapies at a higher level than provided in a nursing home (three or more hours per day). They generally have a doctor on-site at least five days a week. Acute rehabilitations are often hospital-based, although they can be stand-alone facilities. The average length of stay in an acute rehabilitation facility is about 2-3 weeks. This care is also paid out of the Medicare patient’s acute hospital benefit and doesn’t count toward the 100 day maximum skilled nursing benefit. Although it’s possible that patients will be discharged home from an acute rehabilitation facility when they’ve completed their course of treatment, if they’re not ready to return home and continue to require 24-hour care they’re often discharged to nursing homes for skilled services under the Medicare benefit.  

Skilled Nursing Facilities (SNF)

A patient who is able to participate up to two hours per day but can’t participate in the higher amount of therapies offered in an acute rehabilitation facility is often discharged from the hospital to a skilled nursing facility (SNF), also referred to as a nursing home. SNF’s provide 24-hour care from licensed nurses, physical therapists, occupational therapists and speech therapists. Some SNF’s provide sub-acute services, such as ventilator assistance, for patients who no longer require a physician 24 hours each day but do require a higher level of care than most skilled nursing facilities. Depending upon the care the patient requires, skilled services can last up to 100 days (the full Medicare SNF benefit).

Home Healthcare

A patient who is able to return home can receive home health care from a Medicare certified agency. These agencies provide nurses, physical therapists, occupational therapists and speech therapists for a limited amount of time. Home healthcare is designed to help the senior transition to home safely so that he won’t return to the hospital. Home healthcare has limitations and is provided on a short-term basis.

Hospice Care

A patient who is able to return home and is considered to be terminal can receive home services from a Medicare certified hospice program. These seniors will receive nursing, medication, equipment and supplies designed to make him as comfortable as possible until his death. Hospice is designed to supplement the care in the home, not to replace it; if the patient requires more assistance than the family can provide it may be best for the patient to receive 24-hour care in a nursing home.

Even though there are multiple levels and types of care available, it’s still possible that a senior won’t be able to return home and live independently. If that’s the case, it’s possible that he can be placed in a group home or nursing home.