The value of subacute care Featured

7:00pm EDT January 31, 2007

Patients who are recovering from illnesses or accidents often find that the type of care that they require falls into a gray area when they search for providers. Hospitals, known as acute care facilities, are not geared toward long-term recovery needs, and nursing homes often do not have the right staff or treatments to improve the patient’s condition. The subacute care unit has emerged, fulfilling the need for many patients at a lower cost.

The Web site of the American Health Care Association defines subacute care as follows: “Subacute care is generally more intensive than traditional nursing facility care and less than acute care. It requires frequent (daily to weekly) recurrent patient assessment and review of the clinical course and treatment plan for a limited (several days to several months) time period, until the condition is stabilized or a predetermined treatment course is completed.”

Many patients enter the subacute unit with tracheostomy tubes or gastrostomy tubes, and — after aggressive treatment — the tubes often can be removed, says S. Salman Naqvi, M.D., medical director and pulmonary critical care specialist with the Subacute Unit for Coastal Communities Hospital.

Smart Business asked Naqvi what CEOs should know about subacute care.

What is the subacute level of care?

For patients who need to transition from an acute care facility, the subacute unit offers a complete course of treatment, which is generally more intensive than a skilled nursing facility. We often treat patients who may have suffered a head injury or need wound care or aggressive pulmonary hygiene. Some enter the facility in a persistent vegetative stage.

We offer an aggressive course of treatment that includes medical care as well as full rehabilitation services such as speech therapy, physical therapy — including full range-of-motion exercises — and social stimulation.

How does the subacute unit differ from a nursing home?

Nursing homes, or skilled nursing facilities, tend to offer services that are more custodial in nature, and the physician is only required to make monthly visits. In our unit, the patients are seen by a physician every week, and there is a physician on duty every day. We engage in an aggressive course of treatment designed to rehabilitate the patient.

We also employ a teamwork approach in designing and executing a course of treatment and consequently the nurses get to know the patients very well. I meet with the nurses daily, and we discuss each case. Once a month, the entire team, including physical therapists, dieticians, pharmacists and social workers, meet with the patient’s family to review our course of treatment. Family members are very important to patient recovery, so it is important to include them and get their feedback as to how the patient is progressing and can best be treated.

Who can benefit from a subacute unit?

Patients range from 20 to 90 years of age. Some often stay for a few months on a transitional basis, while others actually stay for extended periods of time. Our fees are anywhere from 40 percent to 60 percent less than acute care hospitals, so we offer a cost-effective solution.

How does the subacute unit treat the ‘whole patient’?

We have an activity department, and each patient is taken to the activity room where he or she can watch movies, play games, or listen to stories to create mental stimulation. We also give showers and baths instead of bed baths, and our social services team is involved with the physicians as well.

In an acute facility, the patients often can become depressed; by treating the needs of the ‘whole patient,’ we help to lessen depression.

In addition, we don’t like to over-treat the patients. If they come into the facility with a catheter or an IV line, we work to get those removed as soon as possible. Our goal is to rehabilitate the patient so he or she can be released and returned to a quality lifestyle.

S. SALMAN NAQVI, M.D., is medical director and pulmonary critical care specialist with the Subacute Unit for Coastal Communities Hospital. Reach him at (949) 548-3177.