Sub-acute rehabilitation (SAR) is a transitional level of care for patients following a hospital stay due to serious illness, injury, or surgery. Patients are medically stable but not yet ready to return home. SAR bridges the gap between intensive hospital treatment and independent living by providing continued medical monitoring and therapeutic services. This setting is designed without the high-intensity resources of an acute-care hospital.
Defining Sub Acute Rehabilitation
Sub-acute rehabilitation (SAR) is a specialized, short-term inpatient program focused on maximizing a patient’s functional independence after a medical event. This level of care combines skilled nursing care with various rehabilitation therapies for patients who are medically stable but require professional oversight that cannot be safely managed at home.
SAR is typically provided within a dedicated unit of a Skilled Nursing Facility (SNF). This environment offers a less intense medical setting than a hospital while maintaining 24/7 access to medical professionals. Stays are generally short-term, typically ranging from a few weeks to a month, depending on the patient’s recovery goals.
The purpose of sub-acute care is to help patients regain the strength, mobility, and skills needed for a safe discharge back to their previous living environment. An individualized care plan addresses lingering medical needs and functional disabilities. The care delivery emphasizes progress toward a definitive rehabilitation goal.
Distinguishing Sub Acute from Acute Care
The difference between sub-acute and acute rehabilitation centers on the patient’s medical complexity and the intensity of required therapy.
Therapy Intensity
Acute rehabilitation units are designed for patients who can tolerate a highly rigorous therapy schedule immediately following a severe event. This mandates at least three hours of combined physical, occupational, and speech therapy per day, five to seven days a week.
Sub-acute rehabilitation is suited for patients who cannot withstand this demanding pace, offering a less vigorous schedule. Sub-acute therapy generally involves one to two hours of therapy per day, often five days a week. This manageable pace is appropriate for those with lower endurance or higher medical fragility.
Medical Oversight
Medical oversight differs significantly between the two settings. Acute rehabilitation requires frequent physician involvement, often seeing the patient five to seven days a week.
Sub-acute care provides 24/7 skilled nursing but requires less frequent physician visits. A physician or nurse practitioner typically visits one to two times per week for medical management. This lower frequency reflects that sub-acute patients are medically stable, managing complex conditions requiring continued skilled care and monitoring.
Patient Eligibility and Typical Conditions
Admission to sub-acute rehabilitation requires a medical need for skilled services that cannot be safely provided at home. Patients must have a qualifying hospital stay, usually lasting at least three days, before transfer. The care must be deemed medically necessary and involve services requiring the skills of a nurse or therapist, rather than just custodial care.
A primary criterion for admission is the need for continued therapeutic intervention, specifically requiring at least two types of therapy (e.g., physical, occupational, or speech). The patient’s underlying medical status must necessitate skilled nursing care for issues such as complex wound care, IV antibiotic administration, or monitoring of complex conditions. These skilled medical needs ensure the patient is receiving a level of care beyond what a home health agency could provide.
Common conditions leading to sub-acute placement include:
- Recovery following major orthopedic surgeries, such as hip or knee replacements, where mobility is severely limited.
- Medical events like pneumonia or congestive heart failure exacerbations.
- Stable stroke and neurological events.
- General deconditioning from a prolonged hospital stay.
The Multidisciplinary Care Team and Services
The delivery of sub-acute rehabilitation is centered on a coordinated, multidisciplinary team (MDT) approach to create a unified care plan. Registered Nurses (RNs) provide 24/7 skilled care, handling medication administration, complex wound management, and continuous monitoring of the patient’s vital signs. This round-the-clock nursing presence ensures medical stability throughout the recovery process.
The team also includes Physicians or Nurse Practitioners who oversee the medical care and adjust treatment plans. Social Workers and Case Managers play a significant role by coordinating the patient’s transition out of the facility, including securing necessary equipment and arranging follow-up services like home health.
The core therapy roles include:
- Physical Therapists (PTs): Concentrate on improving mobility, strength, balance, and gait.
- Occupational Therapists (OTs): Focus on activities of daily living (ADLs), such as dressing, bathing, and feeding, ensuring the patient can perform self-care tasks independently.
- Speech-Language Pathologists (SLPs): Address communication disorders, swallowing difficulties (dysphagia), and cognitive deficits.