Implications and Experiences in Postacute Care—Rehabilitation, Long-Term Acute Care, and Skilled Nursing

Abstract

Postacute care is a term used to describe a group of health care providers, caring for patients outside of traditional acute care. The populations served and measures of outcomes are similar, but the services provided may vary by type of setting and individual provider. Managing through the coronavirus disease-2019 (COVID-19) pandemic has been both a challenge and an opportunity to demonstrate the vital role of postacute providers in the health care continuum. National media outlets have highlighted emergency departments, critical care areas, and start-up COVID units in acute care hospitals treating critically ill patients battling COVID-19. Stories of nursing homes in crisis over the rapid spread of COVID-19 have saddened readers of newspapers and social media alike. Postacute providers have experienced the pandemic alongside the acute care hospitals in ways that have highlighted the flexibility of postacute care, challenged leaders to lead with intensity, and demonstrated their importance in the continuum of care. Through a series of interviews with postacute care leaders, this article explores the response to the pandemic from the perspective of providers in postacute care settings.

The impact of the COVID‐19 pandemic on delivering post‐acute care in a low‐ to middle‐income country

“…For example, the pandemic has led to a massive increase in post‐acute rehabilitation use in the United States. 7 Yet, post‐acute facilities are often poorly equipped and staffed to meet the needs of acutely ill patients, predisposing adverse outcomes. 5 , 6 …”

“…Moreover, the service shifts we observed probably reflected pressures to alleviate overloaded acute hospitals, which might have led to unintended consequences not captured by our preliminary data. For example, the pandemic has led to a massive increase in post‐acute rehabilitation use in the United States 7 . Yet, post‐acute facilities are often poorly equipped and staffed to meet the needs of acutely ill patients, predisposing adverse outcomes 5,6 …”

“…The consequences of these changes are to be understood. 5 , 7 Therefore, we investigated differences in post‐acute care admissions before and during the COVID‐19 pandemic in Sao Paulo, Brazil. Understanding post‐acute care attributes during health crises can encourage its development in resource‐limited contexts.…”

COVID-19: The Effects on the Course, Outcomes, and Discharge Destination From Acute Rehabilitation

“…The opening of the COVID-19 rehabilitation unit was in response to the pandemic and need for rehabilitative care to support ongoing recovery for patients. Literature has supported the need for rehabilitative care because of ongoing physical, psychological, and cognitive changes resulting from COVID-19 infection ( Barker-Davis et al, 2020 ; De Biase et al, 2020 ; Hatch, 2021 ).…”

“…Other changes include use of personal protective equipment to reduce the likelihood of spreading the virus, treating patients in spaces separate from non-COVID-19-positive patients, and implementing strategies to manage fatigue and decreased endurance for patients to tolerate therapy. Although not all persons with post-COVID-19-related illness require inpatient rehabilitation services, those who have experienced a loss in function, decreased endurance, deconditioning, or debility can benefit from inpatient rehabilitation ( Hatch, 2021 ). In addition, many patients present to IRFs with comorbidities ( Sheehy, 2020 ) making the course of recovery more complex.…”