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Postacute Care: A Guide for People With Dementia and Their Caregiver

Published:March 03, 2021DOI:https://doi.org/10.1016/j.apmr.2021.01.065
      Many people living with dementia are admitted to the hospital because they are sick or have an injury.
      • Daiello L.A.
      • Gardner R.
      • Epstein-Lubow G.
      • Butterfield K.
      • Gravenstein S.
      Association of dementia with early rehospitalization among Medicare beneficiaries.
      Postacute care is the medical care and therapy that a person receives after being in the hospital. A medical health care team can provide information about postacute care options based on the health and safety needs of the person with dementia. In this education page, you will find information on postacute care, ways to find postacute care services in your area, and questions to ask when making decisions about postacute care options.
      There are many options for receiving postacute care.
      • Faieta J.
      • Flesher T.
      • Faulhaber D.
      Reducing the effects of hospital-associated deconditioning: postacute care treatment options for patients and their caregivers.
      Many people living with dementia receive postacute care at a skilled nursing facility, at their home from a home health agency, or an outpatient clinic.
      • Harris-Kojetin L.
      • Sengupta M.
      • Park-Lee E.
      • et al.
      Long-term care providers and services users in the United States: data from the National Study of Long-Term Care Providers, 2013-2014.
      ,
      • Lin R.Y.
      • Scanlan B.C.
      • Liao W.
      • Nguyen T.P.
      Disproportionate effects of dementia on hospital discharge disposition in common hospitalization categories.
      This education page will focus on these 3 options.
      Common postacute care options for people living with dementia
      • Skilled nursing facility
      • Home health agency
      • Outpatient clinic

      What are skilled nursing facilities?

      Skilled nursing facilities provide a wide range of care. Most people go to a skilled nursing facility for occupational, physical, or speech therapy. Tube feedings, intravenous therapy, and the changing of wound dressings are also provided. More information can be found here: www.medicare.gov/coverage/skilled-nursing-facility-snf-care.

      What are the advantages and disadvantages of skilled nursing facilities?

      Tabled 1
      AdvantagesDisadvantages
      • Complex care 24 hours a day, 7 days a week.
      • Will need to move to a new place.
      • Help with bathing, dressing, toileting, getting in and out of bed, and other needs.
      • Rooms may be shared with another resident.
      • Loved ones will have to travel to the skilled nursing facility to visit with the resident.

      How to choose a skilled nursing facility

      You can use the following link to find a skilled nursing facility close by: www.medicare.gove/nursinghomecompare. Each of the facilities is rated on a scale of 1-5 stars based on staffing, safety inspections, and the quality of care.

      Suggested questions to ask staff

      You can call or visit the skilled nursing facility to talk with the staff. Below are questions you can ask the staff to learn more about the facility:
      • Stockwell-Smith G.
      • Jones C.
      • Moyle W.
      ‘You’ve got to keep account of heads all the time’: staff perceptions of caring for people with dementia.
      • Gilbert J.
      • Ward L.
      • Gwinner K.
      Quality nursing care in dementia specific care units: a scoping review.
      • White D.L.
      • Tunalilar O.
      • Hasworth S.
      • Winfree J.
      The Resident VIEW in nursing homes.
      • Does the facility have a memory care unit?
      • Are there safe indoor and outdoor spaces?
      • Are there activities for people living with dementia?
      • Are the staff trained on how to care for someone living with dementia?
      You can find more questions at the following link: https://www.medicare.gov/sites/default/files/2019-10/NursingHomeChecklist.pdf.

      What are home health agencies?

      A home health agency provides postacute care to people living in their home. They provide skilled nursing care and occupational, physical, and speech therapy. Some home health agencies also provide a case manager. More information about home health can be found at the following link: https://www.medicare.gov/what-medicare-covers/whats-home-health-care.

      What are the advantages and disadvantages of home health agencies?

      Tabled 1
      AdvantagesDisadvantages
      • The person will receive care in the privacy and comfort of their home.
      • A family member may be needed to help with basic needs, such as bathing.
      • The person receives one-on-one care.
      • It may be hard to manage a medical emergency at home.

      How to choose a home health agency

      You can use the following link to find a home health agency in your area: www.medicare.gov/homehealthcompare. The website also rates each of the agencies in your area on a scale of 1-5 stars. This includes a rating for the quality of care and a rating based on a patient satisfaction survey.

      Suggested questions to ask staff

      It is helpful to talk to home health care agency staff about the services they provide and how they meet patients’ and caregivers’ unique needs. Below are questions you can ask the staff to learn more about the agency.
      • Surr C.A.
      • Gates C.
      • Irving D.
      • et al.
      Effective dementia education and training for the health and social care workforce: a systematic review of the literature.
      ,
      • Goh A.M.Y.
      • Gaffy E.
      • Hallam B.
      • Dow B.
      An update on dementia training programmes in home and community care.
      • How many hours of therapy will my insurance pay for?
      • Are staff available on weekends or nights in case I have an emergency?
      • Are the staff trained on how to talk with someone living with dementia?

      What is outpatient therapy?

      Outpatient therapy means the person travels to a clinic or hospital for therapy and then returns home after the session is done. It may include occupational, physical, and speech therapy.

      What are the advantages and disadvantages of outpatient therapy?

      Tabled 1
      AdvantagesDisadvantages
      • Good option for persons who can safely leave their home.
      • Will need to leave home to receive therapy.
      • The clinic or hospital will have exercise equipment on site that a person may not have at home.
      • May only receive therapy a few days each week.
      • Can be difficult for a person living with moderate to severe dementia.

      Suggested questions to ask staff

      Below are questions you can ask the staff to learn more about the clinic.
      • Ries J.D.
      Rehabilitation for individuals with dementia: facilitating success.
      ,
      • Leggett A.
      • Connell C.
      • Dubin L.
      • et al.
      Dementia care across a tertiary care health system: what exists now and what needs to change.
      • What types of therapy are provided at the clinic?
      • Will I always have the same therapist?
      • Have the therapists worked with people with dementia?
      • Are there private treatment rooms?

      Talk with your health care team before making a decision

      There are many options for postacute care. This includes options not described in this education page, such as inpatient rehabilitation facilities and long-term care hospitals. It is important to talk with your health care team before making a decision on a postacute care option. A social worker, case manager, or other person in a health care team can answer questions about eligibility and the types of medical care that is covered by insurance. This information can change or be different from state to state.
      What are other postacute care options for people living with dementia?
      • Inpatient rehabilitation facilities provide more intensive therapy and require that the person with dementia receive therapy for 3 hours each day.
      • Long-term care hospitals provide care to people who need to be in the hospital for many weeks because they have a major injury or severe illness.

      Authorship

      This page was developed by Brian Downer, PhD (e-mail address: [email protected] ); Sara Knox, PT, PhD, DPT; Diana Chen Wong, OTD, OTR/L; Julie Faieta, OTR/L, PhD; and Shilpa Krishnan, PT, PhD.

      Disclaimer

      This information is not meant to replace the advice of a medical professional and should not be interpreted as a clinical practice guideline. This Information/Education Page may be reproduced for noncommercial use for health care professionals and other service providers to share with their patients or clients. Any other reproduction is subject to approval by the publisher.

      Acknowledgments

      We thank the community stakeholders who reviewed this page. The stakeholders included individuals who had a parent living with Alzheimer’s disease or related dementia. In an attempt to keep the language of this page person centered, we aligned our terminology with the stakeholder recommendations we received. Specifically, the term caregiver was used rather than alternative options (ie, care partner). This page is attributed to the American Congress of Rehabilitation Medicine Neurodegenerative Disease Networking Group and the Alzheimer’s Disease Task Force.

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