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The evolution of subacute services: One facility's view

April 1, 2008
by Hector Giancarlo, MD, FACS
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Boomers driving demand for state-of-the-art medical treatment leads the Allendale Community for Mature Living to a major upgrade

In 1996, The American Health Care Association (AHCA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the Association of Hospital-Based Skilled Nursing Facilities defined subacute care as:

…comprehensive inpatient care designed for someone who has an acute illness, injury, or exacerbation of a disease process. It is goal-oriented treatment rendered immediately after, or instead of, acute hospitalization to treat one or more specific active complex medical conditions or to administer one or more technically complex treatments, in the context of a person's underlying long-term conditions and overall situation.

Although this decade-old characterization of subacute care still rings true, the service and the environment in which it is provided is evolving rapidly to meet the medical needs and lifestyle demands of a new generation of patients. Since this care level is not dependent on high-tech monitoring or complex diagnostic procedures, coordinated, multidisciplinary services concentrate on preparing the patient for a return to their home or less intensive care environment.

Team of various disciplines

Based on the long-term skilled nursing care model, the subacute team is comprised of various disciplines. Individual care plans are developed in collaboration with each patient's personal physician as well as in-house medical staff; registered nurses and certified nurse aides; occupational, physical and speech therapists; and dietary and therapeutic recreation specialists. A new addition to the care team includes the appointment of an organizational ombudsman who serves as a vital resource and independent advocate for residents and their families. This team member also works collaboratively with the entire professional and nursing staff to preserve care standards and a high staff-to-resident ratio. At The Allendale Community for Mature Living, a three-tier senior living campus, each of the distinct levels of living maintains its own dedicated staff and an organizational ombudsman.
The allendale community for mature living, allendale, new jersey, has completed a comprehensive renovation and refurbishment project to coincide with its 40th anniversary. a new living room at the allendale nursing home & rehabilitation center, one of several community spaces designed to reflect traditional, home-like décor, encourages residents to enjoy a moment of personal reflection

The Allendale Community for Mature Living, Allendale, New Jersey, has completed a comprehensive renovation and refurbishment project to coincide with its 40th anniversary. A new living room at The Allendale Nursing Home & Rehabilitation Center, one of several community spaces designed to reflect traditional, home-like décor, encourages residents to enjoy a moment of personal reflection


In contrast to long-term care, subacute care is outcome-oriented and designed to be therapeutic for a defined period of time. According to AHCA, the average length of stay ranges from a few days to up to three months, depending on the diagnosis. Typical conditions treated at subacute centers include joint replacement, orthopedic fractures, cardiac rehabilitation, post-chemotherapy, IV therapy, and a wide range of neurological diseases. As a result, desirable skills for subacute care professionals include a balanced mix of medical/surgical or critical care as well as extended care experience.

Hector giancarlo, md, facs, founder, of the allendale community for mature living, allendale, new jersey

Hector Giancarlo, MD, FACS, founder, of the Allendale Community for Mature Living, Allendale, New Jersey


Since the inception of subacute care to provide comprehensive, cost-effective inpatient care that bridges the gap between the acute care setting and in-home services, units have been integrated into hospitals and nursing facilities as well as freestanding centers nationwide. At The Allendale Nursing Home, established in 1967 as the first licensed center of its kind in New Jersey, the escalating demand for subacute care prompted a renewed commitment to launch a broad renovation and service enhancement project focused on the addition of short-term care. Recently completed, the new Medicare-certified Rehabilitation Center, whose 120 beds are dually approved for short- and long-term use, now offers people of all ages an opportunity to recover more fully from an illness or surgical procedure using the latest treatment modalities. These include administration of IV therapy, moderate to intensive rehabilitative services using the most advanced exercise systems and traditional equipment, and providing complex therapeutic wound management.

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