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Subacute care: an important new trend.

And significant enough now to have its own professional organization

Subacute care is increasingly gaining recognition as an important level of care offering cost savings and more focused patient care. Providers and payors are choosing to offer subacute care to a variety of patients with complex medical and rehabilitative needs. The 1993 Case Management Resource Guide now lists over 1,000 subacute and postacute programs in the United States.

The Wall Street Journal described the recent growth of subacute care as a "miniboom." Financial analysts estimate that subacute care is a $1 billion business that should grow into a $5 billion business within the next decade.

For payors, subacute care has become increasingly important as a proactive method of managing the costs and care of medically complex patients. Managed care providers were among the first to discover the value of subacute care. The focus of health care reform initiatives and increasing use of managed care plans is a factor that will contribute significantly to further growth in the subacute care industry. Other factors driving the rapid expansion of subacute care include demographic trends -- the aging of America and gains in survival rates for those patients who have catastrophic illnesses.

The emergence of subacute care as a vital force in American healthcare is evidenced by the recent development of an association of the subacute care industry. The American Subacute Care Association (ASCA) is the non-profit organization for subacute care programs and the administrators, physicians, nurses, case managers, therapists, payors and other health professionals who work with subacute centers throughout America. The American Subacute Care Association is dedicated to advancing the field of subacute care and to providing a national vehicle for information, legislation and education that will enable its members to better serve persons with subacute needs.

ASCA will work with other healthcare organizations to assist in developing standards and criteria and to better define and advance the industry.

Because Clinton Administration and Congressional efforts to control healthcare costs have brought additional attention to subacute care, leaders of ASCA have met with key players in America's healthcare reform debate and are working to include provisions in the Administration's reform plan that will further the development of the industry.

"Subacute Care" Defined

Subacute care patients are sufficiently stabilized to no longer require acute care services but are too complex for treatment in a conventional nursing center. Subacute care programs typically treat patients who are medically complex and require extensive physiological monitoring, intravenous therapy, or pre- or post-operative care.

Subacute centers are usually based in or adjacent to a nursing center or hospital. Many subacute programs now focus on medical specialties, such as physical rehabilitation, cardiac rehabilitation, wound care, infectious disease care, neurological rehabilitation, orthopedic programs, pre- and post-transplant care and pulmonology rehabilitation, including ventilator care. This level of care encompasses services for patients of all age groups, including the specific needs of pediatric and geriatric patients.

Programs offer 24-hour nursing supervision by personnel with acute care or critical care experience, and a dedicated medical director and/or specialized physician. Sophisticated equipment, such as telemetry monitoring, is utilized. Also available are physical, occupational and speech therapy. Most programs also employ full-time case managers or case coordinators that act as a liaison to better serve the needs of the patient. These facility-based case managers work with insurance case managers to track patient progress, set goals and generally facilitate available services.

These programs provide care at significant cost savings compared with traditional acute care. Subacute care is typically 20 to 50 percent less expensive than similar care in a hospital setting.

Some patients often face extended periods of recovery, therefore these programs usually pay more attention to the total health care environment specific to the diagnosis. Most subacute programs offer care in a more home-like setting. Dining and activity policies, for example, usually encourage patients to socialize and adopt normal routines to foster rehabilitation and recovery. Subacute care programs tend to involve family members in virtually every aspect of care. Often, visiting hours are more flexible for relatives and friends. The result is more focused care, more attention in a more home-like setting and significant cost savings.


Professionals and governmental agencies are working on the question of how to lower costs without compromising quality. Subacute care will be part of the answer. True, as healthcare evolves, it is important that we do not lose sight of the primary goal -- to care for the patient. However, if the patient is put first, and placed in the appropriate level of care with only necessary procedures performed, then cost containment will be a natural byproduct.

The role of subacute care is emerging as significant in the continuum of healthcare options. As key industry participants move to unite, subacute care is fast becoming an alternative that is helping thousands of Americans deal with complex medical needs.

Laura Hyatt, Vice President, Managed Care for Country Villa Service Corp., in Culver City, CA, is the Executive Director of the American Subacute Care Association, based in Miami, Florida. For more information on subacute care or the American Subacute Care Association (ASCA), contact ASCA at (305) 864-0396.
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Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Hyatt, Laura
Publication:Nursing Homes
Date:Jul 1, 1993
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