Navigating Through The Occupational Therapy Continuum Of Care

Navigating through the rehab continuum of care as a new occupational therapist or COTA can be confusing. There are so many settings, and all of the phases of rehab may not fully be covered in detail in OT school.

To make navigating through the OT continuum of care easier, this post will take you through the rehab continuum of care from “start to finish,” while also giving you an overview of what each setting entails.

The Typical Path On The Continuum

Refer to this diagram as you learn about each phase of care to understand the course that a patient receiving skilled OT may take. The arrows show you the typical paths, but it is by no means exhaustive.

The chart is meant to show you the likely path a patient would follow if they started in the acute care setting and were appropriate for further OT services in another setting that is more suitable for their situation after they are medically stabilized.

It is not required that the patient visit more than one setting on the continuum; again, it is dependent on the patient’s level of function and rehab needs.

Acute Care

Acute care is the first stop on the rehab continuum. This begins after an individual is admitted to a hospital for medical assessment, usually in the emergency department first.

If the patient is not safe to send home, they are placed in the appropriate hospital unit. These units include the intensive care unit, burn unit, oncology unit, multi- trauma unit, neuro unit, medical/surgical unit, cardiac unit, etc.

The acute care setting is usually the start of the occupational therapy process unless the person is seeking outpatient services from home. The main role of the OT in the acute care setting is to assist in discharge planning and providing shortened, functional interventions when possible. This means the OT helps the doctors and case managers determine if a patient is safe to go home and, if not, treats the patients where appropriate.

Not every person admitted to acute care is appropriate for OT services. For example, a patient would not be appropriate if they are found to be at their prior level of function. If ordered, the evaluating occupational therapist will still do a quick screening or evaluation to ensure they are safe to go home without any further OT services.

Long Term Acute Care

Long term acute care, or LTAC, is a discharge setting recommended for patients who are still needing the medical care and monitoring of acute care but for a lengthened period of time. The setting is similar to acute care but patients have been in the hospital for a longer period of time.

Occupational therapy treatments in this setting are similar to acute care: shorter than rehab settings with a continued focus on discharge recommendations. Treatments may include functional mobility, ADL retraining, positioning, and therapeutic exercise.

Inpatient Rehabilitation

Inpatient rehab is the next step from acute care. The patient may be appropriate if they were at a high level of function before they came to the hospital, has an increased potential for recovery, and is able to tolerate 3 hours of therapy a day, 5-6 days a week.

The patient must also require at least three of these four disciplines: OT, PT, Speech, and nursing services.

Inpatient rehab is the most aggressive therapy setting, and is also the hardest to get approved for as a patient since it is the most expensive for insurance companies.

The length of stays in inpatient rehab are getting shorter, averaging about one to two weeks for a neuro or trauma patient. Orthopedic surgeries won’t usually go to this setting; they’ll either go home with outpatient OT/PT, home health, or possibly subacute rehab.

If a patient has completed their allotted time in inpatient rehab but they are still requiring significant physical assist and still need daily rehab, they can be admitted to subacute rehab. This provides further rehab needed for the patient to continue to progress.

Subacute Rehabilitation 

As stated above, the path of care could go from acute care, to inpatient rehab, to subacute rehab. Oftentimes though, patients in the acute care setting that need further rehab will be sent directly to subacute rehab instead of inpatient rehab.

If the patient is older, has a high level of involvement from their condition, or has a lower prior level of function they will usually be admitted to this setting.

Likewise, if the patient cannot tolerate three hours of therapy a day but cannot yet return home safely, subacute rehab will usually be their discharge setting.

Subacute rehab is usually contracted in skilled nursing facilities (SNFs) and ranges in therapy time per day. On average, the patient gets about 60-90 minutes a day, five days a week.

Home Health Therapy

Patients may receive home health occupational therapy and physical therapy either directly after leaving the acute care setting, or following inpatient rehab and/or subacute rehab.

Home health is recommended for patients who are safe to be at home (with help from family or a caregiver) and can assist with their basic ADLs. The person must be “homebound” and unable to drive to outpatient services to qualify.

Home health therapy is usually much less therapy than inpatient or subacute rehab, usually averaging about 2-3 times a week for 30-60 minutes each session. Treatments include home modification suggestions, DME recommendations, ADL retraining, and therapeutic activities or exercise.

The patient is usually at a higher level of function if they leave directly from the hospital to home with home health.

Outpatient Therapy

Outpatient therapy is generally the last part of the rehab continuum. It is after the patient has made the transitions from acute care, to inpatient and/or subacute rehab, and possibly home health.

Individuals receiving outpatient therapy services are typically medically stable, independent in ADLs or have help with ADLs, and can drive or get transportation to outpatient settings easily. They are not considered homebound if they can attend outpatient therapy.

There are multiple types of outpatient therapy based on the patient’s needs. These can include (but are certainly not limited to): neuro outpatient therapy, hand therapy, general orthopedic outpatient therapy, mental health, industrial & return-to-work programs, and lymphedema programs.

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And there you have it! The occupational therapy continuum of care, from start to finish! It is worth mentioning again that each person’s path will differ along the continuum, with some people needing all stages and some only seeing OT 1-2 times in acute care.

We hope this article helps to give you an idea of the typical pathways for any future discharge recommendations and the different types of OT for adults. If you have any questions, let us know in the comments below!

This post was originally published on December 28, 2016 and updated on July 1, 2021.