staffing a subacute rehab unit

**RosesrReder, BSN, MSN, RN** · Oct 23, 2005

I am looking for infor on how other facilities staff sub acute rehab units in long term care facilities. Currently we are a 30 bed sub acute unit that has recently expanded and has the potential to expand to 45 beds. I am interested in how other facilities staff RN, LPN, and CNA's to a ratio of specific number of patients. Does anyone use a case manager style and what is the responsibilities of the case managers?

Welcome to the site. Enjoy your stay and best wishes to you. :balloons:

CapeCodMermaid, RN · Oct 25, 2005

Our sub-acute unit has 41 beds. During the day shift we have 3 staff nurses each responsible for med, treatments, and calls to the docs on their group of residents. We also have a nurse manager who goes to all the MDS/PPS meetings, care plan meetings, clinical meetings...she also assesses patients when necessary and she is usually the one who makes rounds with the docs. On the 3-11 shift we have 2 nurses and on 11-7 only 1...should be 2 but between budget cuts and not finding any good ll-7 nurses, we have just the one. Our staffing, unfortunately, is based on census NOT acuity. When we're full we have 5 CNA's for days, 4 evenings and 2 nights. When the census goes down, they numbers go down even if the patients are really sick. Not a good way to do business if you ask me, but they haven't asked and it's the way everyone staffs around here. We are mandated to have RN coverage on that unit every shift because we have a lot of managed care contracts. Other than that, we'd rather RN's (oh now don't anyone get all huffy on me...these people are SICK!), but do not say no to an LPN with short term or med surg experience. Just be careful about the term SUB ACUTE. If you are ever looking for Joint Commission accreditation, they will hold you to the subacute standards which are very hard to meet...one being EVERY department must have the admitting assessments done with in 48 hours of admission and the comprehensive care plan must be done with in 5 days of admission. Not easy to do when you get 3 and 4 admits over the weekend. Good luck with your new unit. It'll be a challenge but well worth it when you send the patients home better than they were even before they went to the hospital.

estrogen · Oct 25, 2005

We are a ventilator/sub-accute unit in LTC. We have about 50 beds and we have 3 LPNs, 3 CNA's and 3 RT all the time (2 12 hour shifts a day). We also have a Resident Care Manager.

Nascar nurse, ASN, RN · Oct 26, 2005

On our skilled rehab unit (we don't use the term sub-acute b/c like capecod stated - we don't meet the guidelines for this) we have 44 beds. When full we staff 7-3 with 3 nurses (combo of RN/LPN). The unit manager (which is an LPN - excellent nurse!) runs the "desk", ie: phone calls to family/dr, Dr rounds, follow up on labs, makes appointments, supervision of staff, goes to meetings, etc. The other 2 nurses split the hall for meds/tx and documentation. 4 CNA's. On 3-11's we have one nurse, one QMA (qualified med aide) and 3 CNA's, 11-7 we have 1 nurse and 2 CNA's.

Regarding staffing by census vs acuity, Again, I agree with capecod. It is a joke to staff by census numbers alone. It does not tell the story of what all needs to be done. We also have very sick residents w/ multiple IV's, wound vac tx's, unstable labs, multiple meds, breathing treatments, unstable DM's, etc. Luckily we do not have vents - but that's about it. Now our census is dropping so we are being "pushed" into taking any inquiry... this has added several with extreme psych diagnosis and a couple w/ advanced dementia that requires nearly 1:1 to keep from falling. AND of course, they are cutting staff on top of it because we are not full. :redlight:

CapeCodMermaid, RN · Oct 26, 2005

LOL...Nascar I think we must work for the same company. Open beds MUST be filled at any cost even if the person is a screaming meemie or going through the DT's. Then they wonder why the alert, oriented rehab customers don't want to stay!

Nascar nurse, ASN, RN · Oct 27, 2005

LOL...Nascar I think we must work for the same company. Open beds MUST be filled at any cost even if the person is a screaming meemie or going through the DT's. Then they wonder why the alert, oriented rehab customers don't want to stay!

Yep, gotta to be the same company. I can't convince them that you can't take the "prime" total knee, sweet little ole lady and room her with Zelda from Hellda and think they are gonna stay AND have anything nice to stay about our wonderful facility when they get back out to the community. I know from previous posts that you're also familiar enough with reimbursement to realize that the reimbursement stinks for the behavioral people - it's the hips and knees that bring us good bucks for less time.

ecmcrn · May 25, 2006

Does anyone have any information about subacute brain injury unit staffing? We are hoping to open 2 units and want to get the correct staff mix to ensure patient safety and staff happiness...thanks-