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Acute vs Subacute Rehabilitation

Rehabilitation 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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