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Maximizing Patient Outcomes Through Acute Rehabilitation Units Within LTACHs

By Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals

Many patients recovering from an illness or injury benefit from comprehensive rehabilitation provided in acute rehabilitation units (ARUs). An ARU that is located within a long-term acute care hospital (LTACH) provides patients with a broad range of physician-led rehabilitation expertise while helping them avoid the disruption of being transferred to a separate facility to continue care.

Physicians also benefit from the continuum of care options for their patients and from improved administrative efficiencies. With enhanced capabilities, expertise and clinical integration all under one roof, these units are able to deliver superior care to the most clinically complex patients.

This guide outlines the benefits of comprehensive rehabilitation services on a patient’s recovery, including those recovering from COVID-19.

Clinical Benefits of Acute Inpatient Rehabilitation Services

Patients striving to live independently or return to a prior level of function, but who also still require medical management, have a better chance for recovery in an ARU setting. ARUs may be the most appropriate next level of care for patients coming from any setting including home, hospitals, SNFs, assisted living facilities, or LTACHs. LTACHs specifically specialize in treating patients who often require longer recovery time due to severe illnesses or complications created by multiple chronic conditions. ARUs located within an LTACH are thus structured as comprehensive, hospital-based physical rehabilitation programs, specializing in the treatment of those who have experienced a disabling injury or illness. 
Some of the clinical advantages of an ARU located within an LTACH include:

  • Ease of access – patients who require comprehensive rehabilitation services in a hospital are able to transition to a different care setting without leaving the building.
  • Continued specialized care through the integration of an interdisciplinary rehabilitation team that includes daily access to a physician specially trained in rehabilitation and 24-hour RN coverage. Additionally, specialty physicians from the LTACH are available if requested for patient needs. This level of care is distinct from other post-acute settings, like skilled nursing facilities (SNFs), which have limited clinician availability. Some SNFs have RN coverage for as little as eight hours per day, while others have 24-hour presence only from LPN/LVNs. Some SNFs feature daily physician visits only during the first 30 days, after which the patient receives just one visit every 60 days.
  • Comprehensive therapy with short lengths of stay – patients who receive rehabilitation at an ARU have significantly shorter lengths of stay and substantially lower readmission rates compared to patients discharged from other post-acute settings.1

Hospital System Advantages to ARUs

ARUs complement the specialized care provided by LTACHs, offering providers a continuum of care for patient recovery. Some of the care management benefits of ARUs within an LTACH include:

  • Greater opportunity to meet broader patient needs, as short-term acute care hospitals (STACHs), payer discharge planners and case managers seeking specialized care settings for their patients can access high quality services in one location.
  • Combined knowledge and experience enables clinicians to manage the complex medical care necessary for post-intensive care patients while also leveraging the expertise provided by comprehensive rehabilitation services.
  • Expanded patient care options with a simplified admission process.
  • Known care management practices and clinical staff connections make it easy to add and manage new services.

LTACHs, ARUs and COVID-19

Research demonstrates that specialized services delivered in LTACHs and inpatient rehabilitation settings play a unique and positive role in treating patients diagnosed with, and recovering from, COVID-19. To maximize patient outcomes, long-term acute care and acute rehabilitation care can protect this vulnerable patient population during their recovery through these measures:

  • ARUs are certified as distinct patient units of acute care hospitals, and must comply with the same health and safety requirements as short-term acute hospitals in order to participate in the Medicare program. Many build on this foundation through further accreditation of their specialized services and programs.2
  • Acute inpatient rehabilitation facilities feature hospital-level infection control overseen by a dedicated Infection Control Practitioner (ICP) to administer the hospital and Infection Control Program, whereas other post-acute settings employ a part-time infection control practitioner.
  • ARUs require hospital-quality air filtration, while care settings such as SNFs have the same air handling/quality as the average residential home.
  • On-site acute rehabilitation at LTACHs allows for providers to meet a full-range of patient needs without relying on outpatient services, meaning that patients who access these services within an LTACH can minimize their risk of virus exposure and spread.

How Kindred Can Help

Acute Rehabilitation Units

With the expertise of the acute rehabilitation unit added to a number of our hospitals, we are able to offer greater clinical and rehabilitative care to our patients on their journey to recovery. Our patients benefit from rehabilitation provided by skilled and experienced clinicians, including physical, occupational and speech therapists with supervision and intervention by a rehabilitation physician. With less disruption due to avoided site transitions and the expanded capabilities, we are able to bring new care management strategies to our partners and the community.

Long-Term Acute Care Hospital Services

Additionally, as a long-term acute care provider, we specialize in the treatment and rehabilitation of a wide range of medically complex patients requiring continued intensive care in an acute hospital setting. Kindred Hospitals can be the right partner for your patients who have been in an ICU or a critical care unit, or who are chronically ill and readmit to the hospital frequently. We have proven success in treating patients with pulmonary disease and respiratory failure, including a long history of liberating patients from mechanical ventilation and artificial airways.

Kindred LTACHs with ARUs within:

Kindred Hospital Bay Area – St. Petersburg
Kindred Hospital North Florida
Kindred Hospital South Florida – Fort Lauderdale
Kindred Hospital Houston Medical Center
Kindred Hospital Sugar Land

If you have a patient in need of care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. Our experts will help you determine whether an LTACH or ARU stay is appropriate for your patient. If you are unsure of who your Kindred representative is, please reach out to us at recoveratkindred.com.


References

  1. Data from E-rehab, 2013.
  2. https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/Hospitals
By Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals