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Three Things You Should Know About Sub-Acute Rehab (SAR)

Picture it: Your 89 year old father falls, breaks a hip and spends a week in the hospital. The discharge plan is not to home, but to Sub-Acute Rehab (SAR) — a fancy term for short-term, low-intensity rehabilitation that most often occurs inside of a nursing home.

This is a scenario that plays out thousands of times every day across the country. If your aging parent is in this boat, below are three things you should know…

1) Sub-Acute Rehab is not the same as Acute Rehab — find out for sure which one is being recommended because there is a BIG difference…

  • Acute Rehab is intense — 3-4 hours of rehabilitation per day
  • Sub-Acute Rehab is far less intense — approximately 30 minutes per day

So who determines whether your aging parent is recommended for Sub-Acute Rehab vs. Acute Rehab?  Good question!

That would be the Physical Therapist (PT) in the hospital.

As discharge approaches, “PT” will visit your aging parent at bedside and attempt to get Mom/Dad out of bed with the goal of taking a stroll in the hallway.  Much of the decision is based upon how far (i.e. how many steps) your mom or dad can walk.  If it’s not many, Sub-Acute Rehab will likely be the recommendation.

(Heads up though: if Mom/Dad can walk over 100 feet, he/she may not qualify for either.)

2) If your aging parent has Medicare and has been in the hospital for 3 or more days, there should be no out-of-pocket costs for a Sub-Acute Rehab stay BUT…

If you remember nothing else about Medicare, remember this: it only pays for short-term services (i.e. a few weeks to a month or two at most).  Here’s why that fact is REALLY IMPORTANT when we’re talking about Sub-Acute Rehab…

Imagine for a moment that it’s day 25 of your father’s stay in the Sub-Acute Rehab after breaking his hip. He isn’t much better. Let’s say, for argument’s sake, that he’s worse.  Being away from home depressed him. He didn’t like the food. He didn’t engage in the rehabilitation that was offered.  Instead, he stayed in bed and slept a lot.  After a few solid weeks of this, it’s now tough for him to get up at all.

And while Medicare was happy to foot the bill thus far, they will not continue to pay. So dad has come to a fork in the road. He can:

  • Go home (but because of his physical state he’ll need more help than ever before to bathe and dress, etc.)

or he can…

  • Stay and transition into a long-term, nursing home bed.  (The cost of this could be as much as $14,000 per month. Unless Dad has Medicaid, it will be his responsibility to pay.)

Think the prospects of an indefinite stay in the facility and the depletion of his savings are enough to depress Dad even more?  Yeah, I’ve seen that once or twice.

For those of you who are still with me, you’re probably wondering what the third thing to know about Sub-Acute Rehab could possibly be, so here it is:

3) There is an alternative to Sub-Acute Rehab that’s not often talked about: going home with home care.

That’s right, folks. Just as Medicare will pay for a brief stay in a Sub-Acute Rehab it will also often cover the cost of Physical Therapy at home. Typically this “home PT” occurs several times a week. And, it may also be possible to get Medicare to cover the cost of a home health aide to assist with activities of daily living during the same service window.

Of course there could be reasons why Sub-Acute Rehab may make the most sense for your aging parent.  Maybe he/she has medical needs that complicate the picture so that a discharge to home – even with home care – really would be unsafe.

But do I think you should ask the Physical Therapist and/or the medical team to explain why home PT isn’t best?

You bet I do.

 

{ 2 comments… add one }
  • kat May 2, 2014, 10:12 PM

    I would like to make a comment, I am an experienced Physical Therapist Assistant, and am concerned about the number of minutes a patient is seen in a Sub acute setting. I have worked in at least 10 different Subacute units throughout the area that I live in which is a moderate sized city and I can tell you that patients are seen by Physical therapy and occupational therapist for over 2 hours daily and more for orthopedic patients. I think that some of the information in this article seem a litter bit exaggerated or seem to place therapists in subacute in a bad light. Medicare pays up to 100 days of therapy and any co-pays are paid in conjuction with a supplement insurance in subacute units depending on diagnosis and the need to improve independence. Moreover the patients that end up in subacute usually have multiple diagnoses and cannot safely return independently because of the risk of falls. Better not to have more fractures, fail, and go right back to Acute care. Also there is the idea that Home health can see a patient multiple times through the week, its generally only up to 3 times max for 45-60 mins over less than 4 weeks, a pt in subacute will be seen most likely 6 times a week for over 2 hours. I like home health care when it is best alternative but not when returning home jeapordizes patients safety just going up/down stairs to get in front door.

  • Winnie Malagrino March 22, 2012, 9:09 AM

    Here is the problem, Medicare does not want doctors to see nursing home patients, whether subacute or not, more than once a month….There is no differentiation in the coding to notify medicare of the type of rehab (subacute or long term). (there is an acute code) Therefore, it opens up a bunch of audits and frankly doctors do not have the time for this…..

    I work with a provider and we just got this call today, telling us that we see patients too much in the nursing home……Hello Medicare, these are subacute and sick patients…….

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