CCMC Glossary of Terms Related to Levels of Care
Appropriateness of Setting: Used to determine if the level of care needed is being delivered in the most appropriate and cost-effective setting possible.
Continuum of Care: The continuum of care matches ongoing needs of the individuals being served by the case management process with the appropriate level and type of health, medical, financial, legal and psychosocial care for services within a setting or across multiple settings.
Custodial Care: Care provided primarily to assist a patient in meeting the activities of daily living but not requiring skilled nursing care.
Discharge Planning: The process of assessing the patient’s needs of care after discharge from a healthcare facility and ensuring that the necessary services are in place before discharge. This process ensures a patient’s timely, appropriate, and safe discharge to the next level of care or setting including appropriate use of resources necessary for ongoing care.
Hospice: A system of inpatient and outpatient care, which is supportive and palliative family-centered care, designed to assist the individual with terminal illness to be comfortable and maintain satisfactory lifestyle through the end of life.
Level of Care: The intensity of effort required to diagnose, treat, preserve or maintain an individual’s physical or emotional status.
Levels of Service: Based on the patient’s condition and the needed level of care, used to identify and verify that the patient is receiving care at the appropriate level.
Skilled Care: Patient care services that require delivery by a licensed professional such as a registered nurse or physical therapist, occupational therapist, speech pathologist, or social worker.
Subacute Care Facility: A healthcare facility that is a step down from an acute care hospital and a step up from a conventional skilled nursing facility intensity of services.
Transitional Planning: The process case managers apply to ensure that appropriate resources and services are provided to patients and that these services are provided in the most appropriate setting or level of care as delineated in the standards and guidelines of regulatory and accreditation agencies. It focuses on moving a patient from most complex to less complex care setting.
Levels of Care Important to Case Managers
Acute care is the most intensive level of care during which a patient is treated for a brief but severe episode of illness, for conditions that are the result of disease or trauma, and/or during recovery from surgery. Acute care is generally provided in a hospital by a variety of clinical personnel.
Long Term Acute Care Hospitals(LTAC)-Long-term care hospitals (LTCHs)
According to Centers for Medicare and Medicaid Services, Long Term Acute Care Hospitals(LTAC)-Long-Term Care Hospitals (LTCHs) are certified as acute care hospitals, but LTCHs focus on patients who, on average, stay more than 25 days. Many of the patients in LTCHs are transferred there from an intensive or critical care unit. LTCHs specialize in treating patients who may have more than one serious condition, butwho may improve with time and care, and return home. Services provided in LTCHs typically include comprehensive rehabilitation, respiratory therapy, head trauma treatment, and pain management.
Sub-Acute Care/Transitional Care
Subacute care is a level of care for a patient who does not require hospital acute care, but who requires more intensive skilled nursing care, therapy and physician services than is provided to the majority of patients in a skilled nursing facility.
Inpatient Rehabilitation Hospitals provide intense, multidisciplinary therapy to patients with a functional loss. To qualify for this level of care, patients must be able to tolerate a minimum of 3 hours of therapy per day, 5 to 7 days a week.
Skilled Nursing Facility (SNF)
SNF’s offer 24 hour skilled nursing and personal care. They also have rehabilitation services. Patients must be medically stable to qualify for SNF level of care. They must also have a need that must be performed by a skilled, licensed professional on a daily basis. Examples are complex wound care and rehabilitation when a patient can not tolerate 3 hours of therapy a day.
Intermediate care is a level of care for patients who require more assistance than custodial care, and may require nursing supervision, but do not have a true skilled need. Most insurance companies do not cover intermediate care.
Home Health Care
Home health care provides intermittent skilled care to patients in their home. Skilled nursing, physical therapy, occupational therapy, speech therapy and medical social worker visits are services that home health agencies provide. For a patient to qualify for home health, they must be deemed homebound. To qualify as homebound, the patient must be unable to leave their home or it would require great effort to leave.
Hospice provides end of life care to patients with a terminal illness and supports their families. To qualify for hospice care a physician must document that if the disease follows its normal course of progression, the patients life expectancy is 6 months or less. Hospice care can be provided in the patients home, in the hospital or in a freestanding hospice facility.
Also see Alternative Care Facilities