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As a case manager (or sometimes called as discharge planner) at a sub acute rehabilitation facility, there are a few things that are quite overlooked by the institution and should also be given notice—the staff, their nature of work, the problems that they encounter, and the improvements that the institution can give in order to attain happier and a higher quality of staff. In order to fully understand what a sub acute facility is, P. S. Jones provided its definition, stating that “Acute rehabilitation is designed for patients whose primary goal is a basic functioning, such as walking or sitting upright unassisted.

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These patients must be in a position to complete a whole day of physical therapy, and be able to meet the physical demands required to progress in the program. While the purpose of acute rehabilitation may be to increase mobility, some patients use it to increase their overall stamina or reduce pain performing certain actions. On the other hand, sub acute rehabilitation is suited to patients who cannot tolerate more than three hours of physical therapy each day.” (Jones)


Cherilyn Murer added that, “Generally, sub acute rehabilitation units refer to programs developed to provide inpatient rehabilitation to patients following their acute care hospital stays. However, the Medicare program does not have a separate reimbursement system or payment classification for such a distinction. Therefore, sub acute rehabilitation units must meet the Medicare conditions of participation for skilled nursing units in order to participate in the program and receive reimbursement for care provided to Medicare beneficiaries.” (Murer, 2001)

Based from the information that is provided above, the paper will then seek to explore the nature of work and the problems that are encountered by the staff and the facility per se of a sub acute rehabilitation facility. From the information that will be gathered and analyzed, recommendations will also be given in order to help the institution improve.

The sub acute rehabilitation facility studied provide services that are mainly rehab, including physical therapy, occupational therapy, wound care and long term IV antibiotics. From the data that was gathered, it is said that the volume of activity in the institution is an average of 45. There is also only one registered nurse that will attend to 18 patients.

The certified nursing assistants, on the other hand, provide the non-nursing care. The sub acute rehab facility also has one physical therapist (which is only available during the day), an assistant to the physical therapist, one occupational therapist (also available during the day) and one speech therapist (which is available as needed). The researcher gathered 10 participants of a small sub acute rehabilitation facility. These participants include the staffs of the hospital that were aforementioned.

Data Analysis

It can be noted that the staff of the sub acute rehabilitation facility is already sparse. Basing from the needs and the amount of patients of the unit, it can be said that there is a disproportional amount patients and the staff. It was even mentioned by the registered nurse that only one nurse caters to 18 patients. It was also stated by the RN that they are the only ones who are allowed to give medications to the patients. It should be also noted that the staff are not well aware of the demographics of the hospital.

Perhaps with the tedious work that they have to exert in the unit, the staffs tend to be inattentive with this type of information. They pointed out the older demographic, although it had a series of medical issues. Dementia, also, is a common problem that is encountered by the facility. The facility is also a Medi-Cal certified facility, which almost the same as Medicaid, meaning, the patients that are catered mostly by the unit are those of the lower classes and resources that will assist them after their discharge remains to be very few.

One of the complaints that were gotten from all of the staffs was that they were overworked, most likely because the rehabilitation facility employs a small number of staff. It is said that the rehab unit abides by the California ratio laws, but due to the fact that this is classified as a skilled nursing facility, the ratio for the registered nurse and the patient turns out to be very negative. The patient care is heavy with many patients being non-ambulatory and incontinent upon arrival.

Based from the statements of the respondents, there are two implications that can be gathered: First is that the workers are not satisfied from their work since there is already a consensus amongst all workers that they are overworked. Second is that the job can suffer, most especially for the registered nurses. With 18 patients per one nurse, it is possible for a mix up to happen, perhaps with the administering of medications.

Skin care and prevention of skin breakdown is the highest priority educational need. Of the members of the staff of the rehabilitation facility, it is the CNA’s who needs the highest learning on certain aspects like turning patients, keeping patients clean and dry (to avoid pressure ulcers and skin breakdown).

These processes tend to be tedious since with the current events regarding Medicare, they are no longer reimbursing for preventable nosocomial infections. This non-reimbursement also imply on treatments of preventable conditions and certain infections gotten from the healthcare facilities. (ScumDoctor.com, 2006) Perhaps one thing that does not help the CNA’s or probably one thing that the institution doesn’t do for the quality of the CNA’s is that they do not set-up regular competency or skills drills that will improve or  boost the quality of the workers. The institution also tends to rely on punitive measures—that is, the emphasis is given on licensed nursing education.

Because of this, the CNA’s, being that they are in charge of the non-nursing care, are not given that much attention or perhaps the need to improve their quality is overlooked. Because of this, one thing that the institution can do is to do a reallocation of budgetary funds where the education of non-licensed personnel will also be given a consideration since their jobs also contribute, especially with the current Medicare non-reimbursement law.

Jones, P. S. (n.d.). What is Subacute Rehabilitation? Retrieved March 10, 2010, from Wise Geek: http://www.wisegeek.com/what-is-subacute-rehabilitation.htm

Murer, C. (2001, November). Trends and Issues. Retrieved May 3, 2010, from Rehab Management: http://www.rehabpub.com/departments/112001/6.asp

ScumDoctor.com. (2006). Medicare Reimbursement For Nosocomial Infection. Retrieved May 4, 2010, from Scum Doctor: http://www.scumdoctor.com/insurance/medicare/Medicare-Reimbursement-For-Nosocomial-Infection.html

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Kylie Garcia

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