The evolution of subacute services: One facility’s view

In 1996, The American Health Care Association (AHCA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the Association of Hospital-Based Skilled Nursing Facilities defined subacute care as:

…comprehensive inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process. It is goal-oriented treatment rendered immediately after, or instead of, acute hospitalization to treat one or more specific active complex medical conditions or to administer one or more technically complex treatments, in the context of a person’s underlying long-term conditions and overall situation.

Although this decade-old characterization of subacute care still rings true, the service and the environment in which it is provided is evolving rapidly to meet the medical needs and lifestyle demands of a new generation of patients. Since this care level is not dependent on high-tech monitoring or complex diagnostic procedures, coordinated, multidisciplinary services concentrate on preparing the patient for a return to their home or less intensive care environment.

Team of various disciplines

Based on the long-term skilled nursing care model, the subacute team is comprised of various disciplines. Individual care plans are developed in collaboration with each patient’s personal physician as well as in-house medical staff; registered nurses and certified nurse aides; occupational, physical and speech therapists; and dietary and therapeutic recreation specialists. A new addition to the care team includes the appointment of an organizational ombudsman who serves as a vital resource and independent advocate for residents and their families. This team member also works collaboratively with the entire professional and nursing staff to preserve care standards and a high staff-to-resident ratio. At The Allendale Community for Mature Living, a three-tier senior living campus, each of the distinct levels of living maintains its own dedicated staff and an organizational ombudsman.

The Allendale Community for Mature Living, Allendale, New Jersey, has completed a comprehensive renovation and refurbishment project to coincide with its 40th anniversary. A new living room at The Allendale Nursing Home & Rehabilitation Center, one of several community spaces designed to reflect traditional, home-like décor, encourages residents to enjoy a moment of personal reflection

In contrast to long-term care, subacute care is outcome-oriented and designed to be therapeutic for a defined period of time. According to AHCA, the average length of stay ranges from a few days to up to three months, depending on the diagnosis. Typical conditions treated at subacute centers include joint replacement, orthopedic fractures, cardiac rehabilitation, post-chemotherapy, IV therapy, and a wide range of neurological diseases. As a result, desirable skills for subacute care professionals include a balanced mix of medical/surgical or critical care as well as extended care experience.

Hector Giancarlo, MD, FACS, founder, of the Allendale Community for Mature Living, Allendale, New Jersey

Since the inception of subacute care to provide comprehensive, cost-effective inpatient care that bridges the gap between the acute care setting and in-home services, units have been integrated into hospitals and nursing facilities as well as freestanding centers nationwide. At The Allendale Nursing Home, established in 1967 as the first licensed center of its kind in New Jersey, the escalating demand for subacute care prompted a renewed commitment to launch a broad renovation and service enhancement project focused on the addition of short-term care. Recently completed, the new Medicare-certified Rehabilitation Center, whose 120 beds are dually approved for short- and long-term use, now offers people of all ages an opportunity to recover more fully from an illness or surgical procedure using the latest treatment modalities. These include administration of IV therapy, moderate to intensive rehabilitative services using the most advanced exercise systems and traditional equipment, and providing complex therapeutic wound management.

According to AHCA, most subacute patients were elderly in 1996, with only about one-third younger than 65. Today, baby boomers are the poster children for subacute care. As a whole, boomers exercise more than any other generation and are now experiencing a record number of sports injuries. These include knee joint replacement and surgery to repair cartilage and ligament damage, hip joint replacement, tendonitis, arthritis, and stress fractures of the lower leg and ankle, many of which require supplemental inpatient services unrelated to acute care. Rehabilitative goals at The Allendale Community for Mature Living are established collaboratively by the multidisciplinary staff, the patient, and the family. Objectives address weight-bearing status; range of motion; pain management; use of adaptive equipment such as walkers, wheelchair, or crutches; overall strengthening and endurance; ambulation; and patient and family education. The entire Allendale staff has been fully trained in the latest techniques and services through ongoing continuing education as well as in-service training.

As a result of this changing patient demographic, the physical environment has become almost as important as the quality of skilled nursing and rehabilitative care. Similar to the hospitality industry, accommodations and amenities at subacute centers drive patient choices.

Greater expectations

As part of the preadmission preparation regimen, family members and the patient are now performing due diligence site tours. Some of their requirements include large, spacious private or semiprivate rooms featuring cable television, telephone service and climate controls, comfortable homelike community spaces, attractive dining rooms and gourmet menu selections, a hotel-like entrance lobby, and attractive seating areas for visiting with family and friends. Centers like The Allendale Community even offer luxurious resort-style suites featuring designer fabric wall coverings, plush carpeting, and wood flooring. The concept is to create upscale private living that promotes improved health.

Subacute care has become fully entrenched in our multitiered healthcare delivery model as a vital link between intensive, acute care, and supplementary in-home services. Just like every other facet of their lives, boomers are redefining subacute care. The need among this demographic for short-term rehabilitative care has the potential to span decades, beginning in their late 50s. As this level of care continues to evolve, only visionary providers will succeed in meeting the definitive demands of this new generation of patients. They are driving the market and only those who respond will succeed.

Hector Giancarlo, MD, FACS, is Founder and President of The Allendale Nursing Home & Rehabilitation Center, a Medicare-certified 120-bed skilled nursing center which recently completed a comprehensive renovation and service enhancement project that included the addition of short-term subacute services. The Center is part of The Allendale Community for Mature Living, which offers three levels of residency, including independent and assisted living, and a continuum of care on a suburban campus in Allendale, New Jersey. For more information, call (201) 825-0660 or visit

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