Combination Rehab/SNF? Confused new grad RN

  1. I am a newly graduated and licensed RN/BSN looking for my first nursing job. I'm a bit confused about the differences between various facilities, departments and specialties. For example, I recently learned that there was such a thing as a Long-Term Acute Care (LTAC) hospital, where patients are still acutely ill but have run out of insurance coverage for their stay in a "regular" or "short-term acute care" hospital. Now I'm looking at a job posting for a facility that specializes in "senior rehabilitation and skilled nursing care." Is this a place where most patients will improve enough to be sent home, or will most of the patients be sent to a long-term skilled nursing facility, or is this facility a rehab center for some patient but really functions as a long-term skilled nursing facility for most patients? Is working at a "rehabilitation and skilled nursing care" facility completely different from working as a rehabilitation nurse at a hospital?

    I'm asking these questions here to avoid sounding foolish to a potential employer. Any insight is appreciated! Also, can anyone suggest or link me to a good article that explains the real-world relationships between acute care, LTAC, rehab, SNF, etc.?
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    About Lemon Bars

    Joined: Apr '14; Posts: 113; Likes: 110
    from CA , US

    3 Comments

  3. by   SummerGarden
    Quote from Lemon Bars
    I am a newly graduated and licensed RN/BSN looking for my first nursing job. I'm a bit confused about the differences between various facilities, departments and specialties. For example, I recently learned that there was such a thing as a Long-Term Acute Care (LTAC) hospital, where patients are still acutely ill but have run out of insurance coverage for their stay in a "regular" or "short-term acute care" hospital. Now I'm looking at a job posting for a facility that specializes in "senior rehabilitation and skilled nursing care." Is this a place where most patients will improve enough to be sent home, or will most of the patients be sent to a long-term skilled nursing facility, or is this facility a rehab center for some patient but really functions as a long-term skilled nursing facility for most patients? Is working at a "rehabilitation and skilled nursing care" facility completely different from working as a rehabilitation nurse at a hospital?

    I'm asking these questions here to avoid sounding foolish to a potential employer. Any insight is appreciated! Also, can anyone suggest or link me to a good article that explains the real-world relationships between acute care, LTAC, rehab, SNF, etc.?

    I can answer one of these questions because I have worked in a few hospitals that have an acute care rehabilitation center. The acute rehabilitation unit in the hospital setting is not Long-Term Care nor is it a LTAC. Patients go to that floor through being screened by a medical team then invited based upon strict criteria. Patients in acute rehabilitation centers in the hospital setting are admitted for short stays and ultimately have a plan to go home with a caregiver or more. Some end up in SNFs for a short stay while others end up in custodial care of some kind (These last two scenarios are suppose to be the exception and not the rule).

    In fact, the nursing care offered in an acute care rehabilitation center is very much similar to the pace and complexity of a medical unit. Plus, the therapy received by patients is intense and frequent throughout the day.
    Last edit by SummerGarden on Aug 8
  4. by   RNikkiF
    LTACH is exactly what you describe. Acute care patients who need longer than their insurance will allow in a traditional hospital. Many of these do have limited therapy available for patients. Skilled Nursing/Subacute Rehab is a rehabilitation unit in the same building as a skilled nursing facility - patients typically get about an hour of therapy a day. Patients of any age can be sent there. Some may need continuing therapy, but no longer require three hours a day, which is what they'll receive in Acute rehab. Some will go home, some will stay at the nursing facility for life.

    Acute Rehab patients receive three hours of therapy, six days a week. They also still have ongoing medical needs that have to be managed and their medical status can change quickly. You get a broad range of patient populations in all of those settings, but if you're looking for intense experience, at an LTACH you'll see PICCs, PEGs, VENTS, TRACHS, the ENTIRE line of medical diagnoses.

    In the acute rehab I just left, we had strokes, amps, trachs, LVADs, spinal cord injuries, brain injuries, MS, Parkinson's.. we literally saw it all. Acute rehab patients require a LOT of physical assistance. You'll be transferring patients who require assistance from two people for everything they do, some will need a hoyer or other device, some will need a slideboard. Your main focus will be time management (critical skill!) because your number one priority after medical needs, is ensuring your patients are ready for rehab on time. Your day will revolve around your therapy schedule. You have to ensure your assessment, AM meds, toileting, morning cares and meals are managed and that the patient has enough time to eat, rest, visit, pain managed and that the doctors are aware of any needs the patient needs addressed. It is 100% about time management. That's day shift. PM shift, you're still managing the schedule, meals, etc. and you're also getting the patient in bed for the night. If your facility has 3 shifts, NOCs of course manages the patient's needs during the night, pain management, sleep needs, toileting and they also have an important morning role with helping ensure patients are ready for breakfast and therapy if they have an early start. Labs are usually drawn in the early morning as well. So, as you can see, every shift has an essential role that is affected by the therapy schedule.

    Day and PM shifts interact with different disciplines frequently throughout the day. Teamwork is a must.

    There are also additional Medicare requirements that have to be met and the nurses play a big part in both of those. There are team conferences every week that the nurse has to be at. There are also scoring systems that the nurses have to know and document on to track the patient's progress.
  5. by   hannahkathy123
    Yes this is right. I work in a rehabilitation hospital. Patients usually stay 1-2 weeks according to 1. Insurance coverage and days given and 2. Patients' recovery- how well or poorly they are rehabbing. Most of our patients have Medicare although some have other forms of insurance. At our facility, patients have OT/PT/ST 3 hours a day, 5 days a week for the most part. We have some similarities to long care facilities or nursing homes but our patients only stay for a couple days to a few weeks. We attempt to discharge to home but some do go out acute or go to SNF or other facilities. We have a strong med-surg/ ICU and even psych base. It's tough but rewarding to see patients that came in and couldnt move and they leave walking out the door. That is not every case but sometimes happens.

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