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Post-Acute Care: Resolving the Crisis Part II

Planning for post-acute care following the hospitalization of an older adult can be confusing.  Some of the challenges which families experience were discussed in last week’s column.  A lack of knowledge about options for this type of care is one challenge which can be addressed before this type of care crisis occurs.

Frequently, a short hospitalization does not provide enough recovery time for older adults to immediately resume their prior levels of activity at the time of discharge.  Follow-up post-acute care may be required for therapy, medical treatments, medical monitoring, and/or personal care tasks.  Several options are available, and the amount of insurance reimbursement for each will vary according to the individual’s needs and the setting which is chosen.

Long-Term Acute Care Hospital (LTACH):  The LTACH serves individuals who require an extended period (more than 25 days) of intensive monitoring for complex medical needs such as multiple co-existing chronic illnesses, respiratory failure requiring the use of a ventilator, kidney failure which requires dialysis, complicated wound care, or infectious diseases.  Therapy services are provided as the individual is able to participate. People who have received treatment in a hospital intensive care unit may receive follow-up care in a LTACH, although it is also possible to be admitted from home.  This level of care is paid for by Medicare Part A, although deductibles and co-insurance may apply. 

Acute Rehabilitation (IRF – Inpatient Rehabilitation Facility):  Individuals who are physically able to participate in at least three hours of therapy per day to work toward resuming or improving their prior level of functioning may be discharged to this type of setting.  Medical monitoring is available, but therapy services are the primary focus of acute rehabilitation.  Diagnoses which may be appropriate for acute rehabilitation include stroke, spinal cord injuries, amputation, and trauma such as a fall or car accident. While some individuals may require several months of treatment in an IRF, the average length of stay for most people is about 20 days.  Others may receive only 7-14 days of rehabilitation. An individual who is evaluated in a hospital emergency department but does not require admission may receive treatment in an IRF.  Medicare Part A pays for acute rehabilitation.

Sub-acute rehabilitation:  This type of care is often provided on a short-term unit in a nursing home.  It is designed for individuals who are able to participate in a less aggressive therapy regimen and who also require assistance with their activities of daily living. Medicare will cover the cost of services (therapies plus room and board) in full for the first twenty days if the individual has had a three day hospital admission (but not observation stay).  A copayment is required beginning day 21 up to day 100 before benefits will end.  Specific criteria exist in order for an individual to remain eligible for payment of this Medicare benefit, and few people receive the full 100 days of coverage.

Home Health:  If an older adult is able to safely return home with supplemental services, home health is a desirable option for many people.  Medicare will pay for services including nursing care and/or therapy if there is a medical need and the individual is considered homebound (meaning it is difficult for the individual to leave the house).  Assistance with personal care may also be available.  These services are usually provided on a short term, intermittent basis.    Home health is also available for individuals who do not require hospitalization but because of a health related event and who would benefit from medical monitoring and/or therapy services. Individuals who have fewer safety issues and better mobility who do not qualify as homebound may attend outpatient therapy instead. A referral from a physician is required for either service.

The options described above are designed to meet the immediate post-acute care needs of an individual who has experienced an illness or injury.  The effects of an illness or injury for an older adult may be prolonged and may result in permanent changes in the individual’s ability to independently manage their activities of daily living.  When ongoing assistance is required, services can be obtained through organizations such as home care agencies, adult day centers, the LIFE program, personal care homes, and nursing homes.

Karen Kaslow, RN, BSN