What is Acute Care?
Acute care, also called skilled care, refers to the provision of medical, nursing, or rehabilitative services. It refers to any illness, disease, injury, or surgery that requires the individual to be admitted to a hospital for short-term treatment.
The medical problem refers to a level of healthcare that needs immediate attention yet is not serious enough for admission to an intensive care unit (ICU).
Examples of illnesses that would qualify for admission to an acute care skilled nursing facility are a severe escalation of a chronic medical problem (such as a flare-up of gout, heart failure, sickle cell anemia, etc.), infections such as pneumonia (not requiring ICU-level of care), or urinary tract infection requiring IV antibiotics, motor vehicle accident recovery, etc.
As you can imagine, most people will use this type of service when they fall ill or need a level of care higher than a typical visit to their family doctor for a minor health issue (for example, a sinus or ear infection that can typically be treated with a short round of oral antibiotics). Chances are, you may have had to stay in an acute care hospital yourself some time in the past.
The demand for acute care services is currently high, and this need will only increase in the future due to our aging population.
According to the Hospital Compare List created and compiled by the Centers for Medicare and Medicaid Services (CMS), there are approximately 5,000 acute care hospitals in the United States.
What is a Long Term Care Hospital (LTCH)?
For individuals who need to stay in the hospital for a more extended period, long-term care hospitals, or LTCHs, are more appropriate.
LTCHs are certified as acute care hospitals, but their purpose differs from traditional skilled nursing care hospitals.
Specifically, patients admitted to long-term care facilities are typically transferred from ICUs or critical care units. These patients account for 10-20% of all people admitted to ICUs.
These hospitals offer medical care to patients with multiple complex chronic problems who need a little more time to heal and recover (e.g., complex wound, recovery complicated by poor management of chronic conditions, etc.) and are more likely to return home after hospitalization.
It is important to note that staying in an LTCH is NOT long-term care! That is a separate concept, which I will cover later in this article.
To reiterate, an LTCH stay is not meant for critically ill patients. It is intended for a patient population that is medically stable.
However, they have enough medical needs to continue receiving hospital-level of care, usually longer than 25 days, as stipulated by Medicare.
What is an Inpatient Rehabilitation Hospital (IRH)?
Inpatient rehabilitation hospitals or IRHs are a type of LTCH.
These facilities provide individualized and intensive care to patients recovering from falls, fractures, surgery, motor vehicle accidents, stroke, traumatic brain and spinal cord injuries, joint/hip replacements, or any illness resulting in deconditioning.
The main goal of these inpatient rehabilitation facilities is to improve or restore the patient’s physical and cognitive independence and get them well enough to be discharged from the hospital and back home safely and efficiently. Once home, the aim is to keep people there, prevent rehospitalization, and improve health outcomes.
Another important goal is to restore or improve the patient’s quality of life, and if that cannot be achieved due to the nature of the illness or injury, to at least set realistic expectations for a new baseline quality of life.
An interdisciplinary team of healthcare providers comprising medical professionals, pharmacists, physical therapists, occupational therapists, speech pathologists, and respiratory therapists works together to create treatment plans, therapies, and rehabilitation services to achieve the abovementioned goals.
Let’s explore the specific roles of the specialties I mentioned above.
The Medical Team
The medical team, usually accompanied by a clinical pharmacist who oversees medication appropriateness and safety, will continue to monitor and adjust the medical management of the patient.
The Physical Therapy Team
The physical therapy team will work to get the patient moving again and back on their feet as quickly and efficiently as possible. They are sometimes known as “movement experts.”
They customize treatment plans to minimize pain, improve quality of life, improve gross motor skills, strength and conditioning, and maintain independence.
Physical therapists or PTs also focus on preventing future injury.
The Occupational Therapy Team
Occupational therapy is similar to physical therapy, with some important differences.
Occupational therapists or OTs work with patients to restore their ability to perform their Activities of Daily Living (ADL).
OTs focus on teaching patients how to adapt to their environment and problem-solve due to the loss of previous function and their new health-associated reality.
The Speech Therapy Team
Speech pathologists work with patients struggling with speech and cognitive deficits due to brain injury or stroke. Additionally, they assess patients’ swallowing ability to ensure they do not aspirate or choke on food and liquids. Depending on the facility, some speech pathologists are also trained to conduct cognitive assessments on their patients to determine if they are cognitively impaired.
The Respiratory Therapy Team
Respiratory therapists assess, assist with diagnosing, and treat patients with breathing and lung disorders such as Chronic Obstructive Pulmonary Disease (COPD) and Asthma.
They treat patients with oxygen, give medications to help them breathe better, and assist with mechanical ventilation where necessary.
The Medical Social Worker
The social worker is an indispensable member of the interdisciplinary healthcare team. This professional is well-versed in the ins and outs of the local community’s available social services and resources.
They ensure the patient’s continuing social and emotional comfort is met.
Working very closely with the patient and family member or caregiver, they ensure that the patient is allowed to participate in the planning for their continued care and transfer or discharge back into the community.
What is Long-term Care?
Long-term care is the opposite of acute care. This article will not focus on older adults who are well enough for independent living in retirement communities.
That will be discussed in much more detail in a later article.
For now, we will discuss the needs of older adults who cannot care for themselves and are unable to safely age in place at home.
The usual reason is the loss of their ability to perform their activities of daily living (bathing, dressing, toileting, etc.) and the presence of one or more of the Geriatric Syndromes.
The consequence is the inability of the older adult to live independently.
When we think of long-term care, nursing homes usually come to mind. These facilities care for older patients who need constant care and attention. Medical and nursing staff are available around the clock to care for their residents.
Seniors with Alzheimer’s Disease and other neurocognitive and neurodegenerative diseases may find their homes in these facilities as their conditions worsen. Generally, palliative care or hospice care is also provided to residents.
Assisted Living Communities
Assisted living homes or facilities share many similarities with nursing homes, except they do not need around-the-clock care. The residents in these facilities are still independent but need help with tasks such as bathing or being reminded to take their medications. On-site staff, usually Licensed Practical Nurses (LPNs), are on duty to assist residents’ needs.
Depending on the facility, medical staff may not work after regular office hours. Immediate medical help may not be available in these communities.
Continuing Care Retirement Communities (CCRC)
CCRCs are communities that offer all of the graded living arrangements for older adults.
Essentially, they offer independent and assisted living environments to their residents.
They are all-in-one facilities that allow independent seniors with minimal health and frailty challenges to move to one part of the facility. Then as their general health needs advance, they can move to another part of the facility that provides a higher level of care.
The significant advantage to this system is that the seniors do not have to hassle with adjusting to an entirely new environment, which can be very disorienting to an older adult with cognitive impairment and worsen their confusion.
The major disadvantage of living in a CCRC is the high financial burden on seniors and their families.
There is usually a sizable entry fee to be accepted into the community. Maintenance or service fees are collected routinely, in addition to the room and board and other miscellaneous charges.
This could be a non-starter for many people simply because they cannot afford the high living costs in these communities.
- Acute care hospitals or skilled nursing facilities help treat patients dealing with immediate medical problems that do not require a critical level of care. Hospital stays are generally short-term, less than 25 days
- Long-term care hospitals treat patients who are medically complex and require a higher level of care for more than 25 days
- Inpatient rehabilitation hospitals are meant for intensive rehabilitation of patients, with care provided by a multidisciplinary team
- Nursing homes house residents who have great difficulty living independently, requiring constant staff assistance
- Assisted living communities work best for somewhat independent people, needing minimal assistance with medications and bathing or getting dressed, for example
- Continuing Care Retirement Communities combine independent and assisted living, helping residents make the transition when their ability to live independently declines