This is the Healthcare Delivery Providers part of the Healthcare Marketplace Specialization. This is module 3.1.1, overview of post acute care sites of care delivery. Learning outcomes for this lecture will be, we will discuss what is post acute care and also where is it provided? Long term acute care hospital, post acute care, skill nursing facility, home healthcare, inpatient rehabilitation facility and many more. So for post acute care, I really want you to think about Harlan Reeves. And this is the Harlan that was in the hospital. And think about that time that he was going to be discharged from the hospital into the world of post acute care. So remember the time he went to the skilled nursing facility or the transitional care unit or the other time he went to home healthcare. So all of these services after the hospital stay or the discharge from the hospital are called the post acute care providers, and that's what this module is about. It's very exciting, so let's get started. So let's look at where post acute care is. So acute care we talked about, that's the hospital. And so everything that comes after acute care is the world of post acute care. So skilled nursing facilities, home health care, community based services, and towards the end of life palliative care and hospice. So that's what post acute care, this particular word stands for. Let's look at a couple of different trajectories in post acute care. So in our case study, here's Harlan about to be discharged from the hospital because he had heart failure, couldn't go home, had to go to the skilled nursing facility, got a little bit better. Was discharged home with home health care, and then was followed while he was living at home. With this heart failure clinic and also maybe got some services in other community based services like the neighborhood boards, gyms or pharmacies. So that's one particular trajectory. Another particular trajectory that Harlan and his family are really thinking about and contemplating is after the hospital goes into skilled nursing facility home care and then at home is being maintained by primary care cardiologists and the specialty care cardiologists. And then starts going downhill so doesn't do well, starts declining and that's where we need to start thinking about palliative care and hospice. And if you remember the case study that's what Harlan and his wife, and son and daughter were really contemplating and struggling with. This will be the post acute care roadmap. I've blown it up a little bit. So after the hospital comes post acute care, that's this world. Long term acute care hospital, inpatient rehabilitation facility, skilled nursing facilities, home health care, assisted living facility, other community based services, and then finally towards end of life, palliative care and hospice. Again, a complicated world but we will go slow and dissect each of this providers one by one by one. So let's start with the long term acute care hospital. So it looks and feels like a hospital, it serves very complicated conditions, patient stay for a long term, long stay. So about 25 days, very high acuity and so high cost. The readmission rates are also high because of the high acuity. So a lot of patients do go back into the hospital again, and then they get paid like a short term acute care community hospital through a bundled DRG payment. Inpatient rehabilitation facility is more like a nursing home or skilled nursing facility. Although some can be in a hospital in the form of inpatient rehabilitation units. Acuity is little bit lower now, conditions they serve more the rehab type of conditions. Cost is a little bit lower than the LTAC. They are paid in a bundle payment, and they are feeling the squeeze. We'll talk about this concept of squeeze a lot. They're feeling the squeeze from the LTAC on the one hand, and the skilled nursing facilities on the other. So again, they're right in the middle of both of these resources and kind of getting squeezed from both ends. Skilled nursing facilities this is when patients start becoming call and being called residents. So they're no longer acute patients. There are different kinds of beds in a skilled nursing facility. Patients that stay for short term transitional care unit patients, post acute, recuperating from illness, and then go home. But some patients do stay for very long time. These are the long stay residents and so the typical nursing home that we think about. They serve all kinds of different conditions. There's a lot of variability in the types of services that they provide, both in for profit and non for profit nursing homes. And there's definitely a move in the US around de-institutionalization and getting patients out of nursing facilities and into the community, into residences and their own homes. Let's do a quiz. We come to home health care which is provided at the patient's home. So there are many different types of home health care agencies and home care agencies that we will discuss. This can be skilled or unskilled workers. That paid in a 60 day bundle, we'll discuss that more. A very high variability of services across the home health care industry and they do serve quite a few different conditions. For example, the heart failure that Harlan had. Another type of post acute care is the outpatient therapy like physical therapy or occupational therapy. This can be provided in clinics or the patient is at home, so at home. Patient obviously is gaining more and more independence in their staying at home, they do serve a small number of conditions that can benefit from therapies. There are many different types of recreational therapy, physical therapy, occupational therapy, speech therapy and the like. And again, high variability in the types of services that various agencies provide. Alternative housing, we won't talk about this too much in the module, so I'll discuss it here. Some of these are called assisted living facility, where residents can live in a communal setting or in different units and they can buy up services. So they need transportation they can buy that and pay extra. They need help with cooking, they can buy that up. If they need more care at home, they can buy that up through ala carte menu. So these are the assisted living facilities, not quite nursing. But you can buy up and get more nursing type care in these facilities as well. Now in the US, there is a concept of senior communities. So elders living together in a communal setting. Maybe there's a clinic right on site or maybe sometimes in larger communities, there might even be a hospital. So again, this is emerging as a way to live independently with peers and enjoy life. So again, we've discussed the ala cart menu and the buying up of services in assisted living facilities and in the senior living communities. And there's a myriad of community based services that we will discuss. Social services, public health, transportation, gyms, pharmacies, different types of services for caregivers, and all kinds of different payments. Some through social services and public health, some through governmental support, some through private pay, some through grants. So again, a wide variety of public health and community based services that directly and indirectly impact health. Now the patient is getting much, much, much sicker. For those patients, there is palliation. So health with suffering, emotional, psychological and other benefits. This is now a medical subspeciality. We'll discuss it in great detail coming up. It's pretty misunderstood, yet however it is experiencing rapid growth in the US now given the aging of the population. And also it does help with improved quality of life and reduce overall cost. Finally, a specific benefit through medicare called hospice which is provided for those patients that are in the last six months of their life. It's paid on a per day basis. It can be provided in the patient's home, for short term in the hospital or in houses called hospice houses where some of the patients that are dying, are cared for together in a serene environment. Again, high variability between the not for profit and the for profit hospices across the US. And we will discuss this model in great detail in the upcoming lectures. In summary, this is the world of post acute care, different settings with different competencies and functions. And we've discussed all of these, and we will discuss the various post acute care providers in great detail, in the upcoming lectures and lessons.
