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Acute vs Subacute Rehabilitation

exoskeleton outpatient physical rehabilitationRehabilitation occurs at a pivotal point in the recovery process, so choosing the appropriate level of care is important. While many healthcare providers describe their services as rehabilitation, the level and intensity of care can vary greatly from one to the next.

This chart provides an explanation of acute vs. subacute rehabilitation services. These resources will help determine what is best for you or your loved one. Prior to admission at our inpatient rehabilitation hospital, Sheltering Arms Institute, one of our clinical referral liaisons or physicians will assess the patient to ensure that he/she can benefit from intensive inpatient physical rehabilitation services and to arrange for the transition to our hospital if appropriate.

Acute vs. Subacute: Physical Rehabilitation Services Compared

Inpatient Rehabilitation Hospital* Skilled Nursing Facility Long Term Care Hospital Home Health Outpatient Rehabilitation**
Length of Treatment Average 10-18 days Average 25 days 25 days or longer Variable, based on treatment plan Variable, based on needs
Therapy Intensity Intensive, skilled care; often integrating advanced technologies Less intensive than inpatient rehabilitation, but not regulated As needed, usually low intensity Variable, based on treatment plan Variable, based on needs
Amount of Therapy Typically 3+ hours per day Typically 1-1.5 hours per day (up to 3 hours) Variable 30-60 minutes per session & discipline, usually 3 times per week 30-60 minutes per session & discipline, 2-3 times per week
Physician Involvement Daily face-to-face assessment and treatment plan update At least every 30 days Available, not on-site daily Provide oversight but no direct treatment As needed to evaluate progress and assess treatment plan
Skilled Nursing Care – RN Care from RN 24 hours per day RN on site for at least 8 hours/day, care typically provided by techs 24 hours/day As needed per treatment plan N/A

* Offered at Sheltering Arms Institute, a collaboration with VCU Health.
** Offered at Sheltering Arms Outpatient Rehabilitation Clinics. Physician services are only offered in our concussions therapy program.

Inpatient Rehabilitation Facilities (IRF) vs Skilled Nursing Facilities (SNF)

For people seeking rehabilitation services, there are typically two options: An Inpatient Rehab Facility or a Skilled Nursing Facility. Below is a chart that outlines the differences between these options to help determine which option best meets the person’s current medical and rehabilitation needs.

Service Inpatient Rehabilitation Facility (Hospital) Skilled Nursing Facility
Physician Visits Daily 1-3 times per week
Type of Physician Physiatrist, a doctor who specializes in physical medicine and rehabilitation (24-hour availability Geriatrician, internist, or family practitioner (Limited availability)
Consultants All specialties readily available Limited specialist availability
Nursing Hours of Care 5.5 and higher hours per day, primarily registered nurses (24-hour availability) 2-3 hours daily, primarily certified nursing assistants
Nursing Skill Mix Professional registered nurses specializing and certified in rehabilitation nursing Nursing assistants certified in long-term care with LPN/RN supervision
Function Complex level of care, patient and family education Basic level of care support
Integration of Care Coordinated multidisciplinary team directed by physician Several individual disciplines
Average Length of Stay 10-35 days, depending on diagnosis 24-60 days
Therapy Intensity 3 hours per day, 5 days per week 45-90 minutes, 3 times per week
Team Meetings Multidisciplinary team meetings lead by physician including family Several individual disciplines
Neuropsychologists Full-time Limited
Physical and Occupational Therapy Registered physical and occupational therapists Physical therapy assistants and certified occupational therapy aids deliver much of the care
Audiologist, Therapeutic Recreation, Social Worker Full-time Limited
Speech Language Therapist Full-time Limited
Accreditation Joint Commission None
Quality Improvement Quality Assurance/Utilization Review None
Driver Training Full-time None
Prosthetist/Orthotist Full-time Limited
Prosthetist/Orthotist Evaluated by licensed clinician and accepted by medical doctor Accepted by admissions

Sources: DaVanzo, J. E., Ph.D., M.S.W., El-Gamil, A., Li, J. W., Shimer, M., Ph.D., Manolov, N., Ph.D., & Dobson, A., Ph.D. (2014). Assessment of Patient Outcomes of Rehabilitative Care Provided in Inpatient Rehabilitation Facilities (IRFs) and After Discharge [Abstract].

What is Inpatient Rehabilitation?

Inpatient rehabilitation refers to physician and therapy services received during a hospital stay. The majority of our patients come to us after being stabilized at an acute care hospital, but others are admitted directly from the community. Patients participate in intensive therapy for at least three hours a day, five or more days a week using cutting-edge rehab technology.

What are Typical Inpatient Diagnoses?

Diagnoses may include amputation, brain injury, cancer, generalized weakness, multiple joint replacement, multiple sclerosis, neurodegenerative disease, neuromuscular disorder, spinal cord injury, and stroke. Patients often have multiple medical complications that must be effectively managed to enable them to participate in therapy and set the tone for ongoing recovery. 

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