Navigating through the rehab continuum of care as a new occupational therapist or COTA can be confusing. There are so many settings, and the phases of rehab may not be covered in detail in school.
To make this 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 rehab 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 will typically 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 in another setting more suitable for their situation.
Remember that at any time, the patient may be discharged to go home. Also, it is not required that the patient visit more than one setting on the continuum.
Acute care is the first stop on the rehab continuum. This begins after an individual is admitted to a hospital for assessment, usually in the emergency department.
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, neuro unit, medical/surgical unit, cardiac unit, etc.
This setting is usually the start of the occupational therapy process when appropriate. The main role of the OT in the acute care setting is to assist in discharge planning and providing shortened interventions when possible. This just means the OT helps the doctors in charge 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. The 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 Facilities
Inpatient rehab is the next step from acute care. The patient may be appropriate if he/she was 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 three of these four disciplines: OT, PT, Speech, and nursing services.
It 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, home health, or possibly subacute rehab.
If a patient has completed their “alotted” time in inpatient rehab but is still requiring significant physical assist and still needs daily rehab, they can be admitted to subacute rehab. This provides further rehab needed for the patient to continue to progress.
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, 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 90 minutes a day, five days a week.
Home Health Therapy
Patients may receive home health occupational 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) and can assist with 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 is generally the last part of the rehab continuum. It is after the patient has made the transitions from acute, to inpatient and/or subacute rehab, and possibly home health.
Individuals receiving outpatient therapy 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.
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.
There you have it. The occupational therapy continuum of care, from start to finish! Of course, each patient’s path will differ along the continuum, with some needing all stages and some only needing home health or outpatient.
I hope this helps to give you an idea of the typical pathways for your future discharge recommendations.