Post-Acute Care (PAC) describes the services a patient receives after a stay in an acute care hospital for a sudden illness, injury, or surgery. PAC provides necessary medical and rehabilitative services to help patients recover and regain independence. It ensures a safe and effective transition from high-intensity hospital care to a less medically intense environment. The goal is to stabilize medical conditions and restore function, reducing the risk of hospital readmission and improving the patient’s quality of life.
Understanding Post-Acute Care
PAC services are defined as rehabilitative or palliative care following an acute medical event. This care is distinct from standard long-term care because it is goal-directed, focusing on recovery and restoration of the patient’s prior level of functioning. PAC duration is typically short-term, varying from a few days to several weeks, depending on the patient’s condition and recovery progress.
PAC includes a wide range of specialized services customized to the patient’s needs. These often involve intensive rehabilitation therapies. Physical therapy rebuilds strength and mobility, while occupational therapy helps patients relearn skills for daily routines like dressing and bathing. Speech therapy is common for patients recovering from a stroke or brain injury, focusing on communication, cognition, and swallowing difficulties.
The medical component of PAC includes skilled nursing care, involving 24-hour monitoring, medication management, and complex treatments. Examples include intravenous (IV) therapy, specialized wound care, and management of medical equipment. PAC is often required for recovery from conditions like hip fractures, joint replacements, stroke, severe infections (such as sepsis), and chronic respiratory ailments (like COPD exacerbations). The focus remains on medical stabilization and functional improvement to achieve the highest possible level of independence.
Facility Categories of PAC Providers
Post-Acute Care is delivered through a continuum of four primary provider categories, each offering a different intensity of care. The choice of setting is determined by the patient’s medical needs, the required level of therapy, and their overall complexity. These settings are covered under Medicare, which is the dominant payer for PAC services.
Skilled Nursing Facilities (SNFs)
Skilled Nursing Facilities (SNFs) provide 24-hour skilled nursing care and rehabilitation services. They serve patients who require medical supervision but not the constant, intensive care of a hospital. Patients typically stay in a SNF for a few weeks to receive therapy and care for conditions like joint replacements or recovery from pneumonia. SNF care is multidisciplinary, balancing medical attention and rehabilitative efforts toward returning home.
Inpatient Rehabilitation Facilities (IRFs)
Inpatient Rehabilitation Facilities (IRFs) offer the most intensive level of rehabilitation. Patients must be able to tolerate and participate in at least three hours of combined therapies per day. IRFs are designed for patients recovering from severe functional losses, such as those following a stroke, spinal cord injury, or major trauma. The care team is led by a rehabilitation physician (physiatrist) and includes a specialized team of therapists.
Long-Term Care Hospitals (LTCHs)
Long-Term Care Hospitals (LTCHs) treat patients with multiple, complex medical conditions requiring an extended hospital stay, often exceeding 25 days. These facilities specialize in medically fragile patients needing prolonged mechanical ventilation, complex wound management, or multiple organ support. LTCHs provide a level of care similar to an intensive care unit, but for a much longer period.
Home Health Agencies (HHAs)
Home Health Agencies (HHAs) provide skilled care directly in a patient’s residence for those who are considered homebound and require intermittent nursing or therapy services. Services include wound dressing changes, medication instruction, and short-term physical or speech therapy. HHAs allow medically stable patients to return home and continue recovery in a familiar environment.
Navigating the Transition to PAC
The transition from an acute care hospital to a PAC provider begins with discharge planning, initiated early during the hospital stay. A hospital discharge planner (often a social worker or case manager) assesses the patient’s clinical needs, functional status, and home environment to determine the most suitable PAC setting. This assessment considers the patient’s ability to participate in therapy, the complexity of their medical needs, and their social support system.
Selecting the appropriate PAC setting is a collaborative decision involving the patient, their family, the physician, and the discharge planning team. Patient preference and insurance coverage play a significant role in the final placement determination. This planning ensures continuity of care, meaning the medical information and treatment plan follow the patient seamlessly to the next level of care.
A proper transition aims to prevent medical errors, particularly those related to medication management, and reduce the likelihood of hospital readmission. The transfer of health information, including care preferences and medical history, is a regulated aspect supporting care coordination. Effective discharge planning provides the necessary support and education to the patient and their caregivers for a safe and successful recovery.
Funding and Oversight of PAC Services
PAC providers operate within a complex financial and regulatory structure, with the Centers for Medicare & Medicaid Services (CMS) serving as the primary oversight body. Medicare is the largest payer for PAC services, and its payment rules heavily influence how care is delivered. Each category of PAC provider is paid under a specific Prospective Payment System (PPS), which sets a predetermined rate for services.
These PPS models pay a fixed fee based on the patient’s condition and expected resource use, rather than the actual cost of each service. This structure creates an incentive for providers to deliver care efficiently while managing quality. Payment methods vary by setting:
- IRFs and LTCHs are generally paid per patient discharge.
- SNFs are paid a per diem rate.
- Home health agencies are paid per 60-day episode of care.
The regulatory framework ensures quality, standardization, and accountability across the varied PAC settings. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) mandates that all PAC providers—SNFs, IRFs, LTCHs, and HHAs—report standardized patient assessment data. This data collection allows for comparisons of patient outcomes, quality measures, and resource use across different facility types. The long-term goal is to inform Congress on developing a unified PAC payment system that bases payment on patient characteristics rather than the setting where the care is delivered.