The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

JCAHO In Subacute Care

Patrick J. Dunne, MEd, RRT Wednesday, November 6, 1996

In 1994, the Joint Commission identified a growing need and demand for a subacute care survey protocol. This need/demand emanated from a growing number of nursing homes applying for accreditation who also offered subacute care units. Further fueling the need/demand was a growing propensity for managed care organizations to require, as a condition of contracting, accreditation for providers of subacute care services. Joint Commission's initial efforts in this undertaking was to examine existing standards in place for long-term care facilities to determine whether they could be applied to the various types of subacute care services offered within a nursing home. The next step was to identify additional requirements unique to the subacute care setting.

As a direct result of the findings, intent statements were drafted for specific long-term care standards to make them directly applicable to subacute care. Additional standards for physician credentialing and privileging, respiratory services, and anesthesia services were adopted from acute hospitals manuals. Finally, new scoring guidelines were developed for the new standards and included in the Joint Commission's 1996 Accreditation Protocol for Subacute Programs. As it now stands, a long-term care organization with a subacute care program would be expected to comply with Joint Commission's long-term care standards and intent statements found in the Accreditation Manual for Long-Term Care in addition to the Accreditation Protocol for Subacute Programs.

One area where subacute care practice standards exceed those for long-term care is in the role played and the degree of involvement of an internal case manager in the care planning and monitoring process. Although not required per se, internal case managers are strongly recommended by Joint Commission. Case managers are viewed as individuals who can best assume responsibility for ensuring that care progresses within set time frames; that essential equipment and services are readily available, and is someone who can serve as a liaison between the patient, the clinical team, the payor, and the family.

As the healthcare landscape continues to adapt to market-driven reform initiatives, the role played by subacute care providers will no doubt also change. Such will also be the case for those mechanisms used to promote high quality care, services, and outcomes in subacute care. Accordingly, Joint Commission accreditation is certain to remain a significant factor for providers of subacute care in all types of institutional settings.

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