Acute Rehabilitation Versus Subacute Rehabilitation: What’s The Difference?

Acute or subacute rehabilitation?

Imagine you get a call from your Mom’s case manager at the hospital. It’s getting close to time for her to discharge, and the case manager said the therapists are recommending acute rehabilitation, but she might not meet the requirements for it and will need subacute rehabilitation instead. What does that mean? Isn’t rehabilitation just rehabilitation? The answer to that is yes and no.  It is rehabilitation, but the two have many differences. 

One difference is the location. Usually, subacute rehabiliation is located within a long-term care facility (aka nursing home). It is often its own unit within the building and separate from patients on the long term care portion. Acute Rehabilitation usually occurs with either a free standing acute rehabilitation hospital or an acute rehabilitation unit that is located within a hospital. 

Another difference is the medical oversight. In acute rehabilitation, Medicare requires at least 3 face-to-face rehabilitation physician (aka Physiatrist) visits per week, but patients are generally seen by the physician  5-7 days per week. There might be a Nurse Practitioner or Physician Assistant that fills in on some of those days. Subacute rehabilitation requires visitation by a physician every 30 days. Many subacute rehabilitation facilities are also staffed by a NP or PA that works closely with the physician.

This person completes visits 1-2 times per week for closer medical oversight. In both cases, even when the physician or NP/PA is not in the building, there is always someone on call to address any issues that might occur. When a patient is screened for appropriateness of acute rehabilitation, the screener is looking to see if the patient has the medical necessity to be seen at least three days a week by the Physiatrist.

Type of therapy while in acute or subacute rehabilitation.

For subacute rehabilitation, patients must show a need for one of the therapy disciplines, which includes physical therapy (PT), occupational therapy (OT), and speech therapy (ST). The patient will generally receive both PT and OT and will be screened by the speech and language pathologist to determine if the patient will need ST services. A patient must need at least two therapy disciplines, with one of those being PT in order for a patient to meet the requirements for acute rehabilitation. 

Another difference between the two is the amount of time one spends in therapy. For acute rehabilitation, the patient gets 180 minutes of therapy daily for five days a week. Those 15 hours of therapy can be spread out over seven days in extenuating circumstances (i.e. changes in medical stability), but the general expectation is that it is 180 minutes per day. The patient must be able to tolerate this quantity of therapy, otherwise, they will need to go to subacute rehabilitation. The amount of therapy one receives in subacute rehabilitation can range from 60-90 minutes per day. 

Length of stay in acute or subacute rehabilitation.

The average length of stay is quite variable for both levels of rehabilitation, but generally, the length of stay tends to be longer in subacute rehabilitation. Traditional Medicare covers the first 20 days of subacute rehabilitation after hospitalization, so this is often an average of how long someone will stay in subacute rehabilitatioin. In regards to acute rehabilitation, the average length of stay is two weeks. In the end lengths of stay are determined by a patient’s diagnosis and medical needs, functional scores on admission, and their progress with rehab. 

Decision for acute versus subacute rehabilitation.

Most often, the decision for the most appropriate level of rehabilitation is made by the admission screeners for the facilities and often, ultimately, by the insurance company. It is still important to know the differences between acute rehabilitation and subacute rehabilitation. That knowledge can help you understand why the decision for the particular level of care was made and what the type and amount of rehabilitation will be.

Please contact me or leave a comment if you have a question about the differences between acute and subacute rehabilitation.

© 2020 Jessica Kluetz, DO