The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

Home Care and Subacute Care: What Should We Teach Our Students?

Patrick J. Dunne, MEd, RRT

Respiratory therapists practicing in the subacute care and home care setting face challenges not typically encountered by their colleagues in the acute hospital. The primary contributing factor is one of environment, although the focus of care in both subacute and home care is likewise very different. It is therefore incumbent that respiratory therapists electing to move beyond the confines of the more traditional acute care hospital possess competencies unique to the respective site of practice they choose.

In subacute care, the primary objective is to bring a patient-resident to a level of clinical stability and functionality such that transfer to a lower level of care can safely occur in a reasonable timeframe. In this respect, the discharge planning process begins at the time of admission, with the performance of a comprehensive assessment. Data collected is then used to craft an individualized, multidisciplinary care plan, which is used to monitor progress and the attainment of intended goals.

In home care, the primary objective is to achieve successful collaborative selfcare, wherein the patient-customer steadily assumes full responsibility for managing their respective chronic medical condition. An individualized regimen of patient education and training, focusing on specific needs or problems identified through a comprehensive assessment, represents the most important component in this undertaking. Unlike their counterparts in both the acute and subacute care setting, home care respiratory therapists often find themselves practicing with limited resources and in uncontrolled environments.

Increasingly, respiratory therapists practicing in both subacute and home care are expected to consider the cost impact of all care and services being rendered. Thus, aside from possessing the clinical and technical competencies required to optimally perform the tasks described above, therapists practicing in these postacute care venues must likewise have an intrinsic understanding of the economics of health care, especially the phenomena of risk-sharing and pre-paid global budgeting. Those able to effectively and consistently make care/service decisions in the context of cost considerations will find themselves well-regarded and in high demand.

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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