Emergency rooms are busier than ever, and a large percentage of the patients visiting ERs end up staying overnight for at least one night. Many ER visitors are also over the age of 65 and more often than not these patients require an extended stay in the hospital.
Common conditions requiring hospitalization include congestive heart failure, strokes, pneumonia, falls resulting in fractures, and other heart-related conditions such as heart attacks and heart rhythm disorders. Older adults are typically hospitalized for routine surgeries such as knee replacements and hip replacements as well.
In the last 10 years, I’ve observed a big change in the length of hospital stays. In the past, joint replacement patients stayed in the hospital for at least three days with a transfer to rehab for therapy services for another 3-7 days.
Now, many joint replacement patients go home within a day or two of surgery and patients with complicated medical conditions are also moving out of the hospital at a faster rate.
With hospital stays getting shorter and older adults not being fully recovered at the time of discharge, many patients are being transferred to a post-acute care facility. These facilities have professional caregivers and offer physical therapy (PT), occupational therapy (OT), and speech therapy (ST) staff.
These post-hospital care settings include acute care rehabilitation, sub-acute rehab, or a long-term acute care hospital (LTACH). You’re probably wondering what type of post-hospital care options are available.
Here are 3 of the most referred facilities and what you can expect to find at each:
Acute Care Rehab: Patients admitted to an acute care rehab setting have serious traumatic injuries, debilitating diseases, and conditions that require intensive treatment from multiple medical providers. Patients with traumatic brain injuries, strokes, amputations, and complex medical conditions will receive a minimum of three hours of intensive PT, OT, and ST each day for up to six days a week. Many patients will also require respiratory therapy. Acute care rehabs are staffed by specialty trained rehab physicians. You can expect to stay there for about 16 days.
Subacute Care: Nursing home based subacute care is for patients that have less severe medical conditions. Patients are typically recovering from fractures, surgery, or medical conditions that make it challenging to go directly home from the hospital. Patients usually receive 1-2 hours of combined therapies each day. You should pay particular attention to what’s required for your health insurance plan before agreeing to a transfer to sub-acute rehab. Average lengths of stay in these facilities are between 14 and 28 days. (NOTE: Some Medicare plans require a 3-night hospital stay to qualify for insurance coverage of care. Managed care plans can waive the minimum stay to decrease hospital lengths of stay.)
Long-term Acute Care Hospital: LTACH care is typically provided in a hospital-based care facility for patients with a complicated recovery who need prolonged hospitalization. Patients with complex medical conditions like burns, severe wounds or other traumatic injuries that require intravenous medications, fluids, or nutrition also need LTACH. In addition, patients need frequent diagnostic testing, wound or burn treatments, or are being weaned from a ventilator. The average length of stay in an LTACH is 30 days.
Let’s face it, as people live longer and are treated for increasing complex medical conditions, many older adults are unable to return directly to their homes. This means that making the decision of what type of post-hospital care you require should be discussed with your hospital care providers prior to surgery or during emergency room visits that turn into hospitalizations.
You may also want to consult with a health advocate to help you select the best facility in your local area.
Next Up: How your health advocate will help you with discharge planning from the hospital and post-hospital care facilities.
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