The idea of sub-acute care following acute care in hospital is to give the patient a better chance of success and of remaining out of the hospital in the near future. It costs Medicare a whole bunch more to provide care in the acute setting than in the sub-acute. So the 3-day stay, if truly warranted, starts the process of assuring the patient a more healthy and active life with a better chance at remaining that way. Our local hospital follows this rationale, but I know of a hospital in a nearby town that discharges after a 2-day stay, so the patient goes home unprepared for the challenges of dealing with the illness or the deficit. If they truly can't go home they end up paying privately for rehab. I'm glad I don't live or work there!
Sally


[EMAIL PROTECTED] wrote:

Our facility has scheduled dc meeting planned once rehab eval is done.We meet 3x a 
week for med a and managed care patients.We go over the rehab plan and get a meeting 
planned 1 week before discharge.These meeting sometime make rehab reconsider their 
plan and sometimes extend, other times the date of dc rehab stands.Most of our 
patients need their families involved in the dc plan,sometimes we only involve the 
patient.On occasion we keep them 1 or 2 days after rehab stops for varying 
reasons.Perhaps they live with families or family involvement helps facilitate a safe 
discharge.I am finding that the residents we are discharging are often in their late 
80s' or 90s',familities are also elderly with sick spouses so their ability to help 
the resident I feel impacts a safe discharge.Most of these patients that I speak of, 
have medical issues that we could keep them for, but the snf is not the most practical 
place to be.My facility is in the northeast and am seeing patients be readmitted to us 
multiple times the past few months.I wouldd s
ay almost 75% of them are in acute care ONLY 3 overnights,just enough to get them a 
snf stay.One particular patient has been here repeatedly.She has a daughter to helps 
her out and everytime the daughter goes on vacation,she comes to us after acute care 
stay.This week she comes again.I jokingly asked the Dr if daughter on vacation,no this 
time she's had a hip replacement.When I mentioned to Dr about the qualifying acute 
care stay always only 3 overnights.He told me without any reservation that this is 
being done all the time.I am tempted to write to CMS .Are others seeing this happening 
around the country.Then I wonder if acute care discharges them after 3 days so they 
can benefit from DRGS.I am glad that I am at the end of my career because I fear there 
is alot of fraud in the system and I think how honest we as MDS/PPS coordinators are 
in interpreting the med A guidelines.

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/---------------------------------------------------------- The Case Mix Discussion Group is a free service of the American Association of Nurse Assessment Coordinators "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your questions posted to NAC News and FAQs. For more info visit us at http://www.aanac.org -----------------------------------------------------------/

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