Nursing Home And Subacute Care During The 19th

Nursing Home And Subacute Careduring The Nineteenth And The Twentieth

Nursing homes have historically been synonymous with long-term care, providing residential care for the elderly and chronically ill individuals. Over time, the terminology used to describe these facilities has evolved, reflecting changes in their roles, services, and societal perceptions. The shift from the term "nursing home" to "nursing facility" represents an effort to reframe these institutions away from the connotations of custodial, institutionalized care toward a more comprehensive, health-oriented model. Additionally, the emergence of subacute care as a specialized segment within the healthcare continuum signifies advancements in addressing patients' varying acuity levels.

This paper examines the implications of changing terminology, explores the development and role of nursing facilities and subacute units, and discusses their impact on healthcare quality, costs, and future directions. It also analyzes the integration of subacute care within hospitals and long-term care systems and compares key aspects such as funding, staffing, regulation, and marketing.

Change in Terminology: Nursing Homes to Nursing Facilities

The transition from "nursing home" to "nursing facility" reflects a broader trend toward destigmatization and a focus on clinical and rehabilitative services. "Nursing home" often connotes custodial or custodial care for frail elderly individuals, sometimes associated with negative stereotypes regarding quality and institutionalization. Conversely, "nursing facility" emphasizes the medical model, signaling a focus on health maintenance, rehabilitation, and recovery (Bowers et al., 2002).

The change in terminology influences public perception, policy, and funding priorities. It aligns facilities closer to the hospital and outpatient care settings, encouraging perceptions of rehabilitation and dynamic care rather than mere custodial support. This linguistic shift also helps distinguish the roles of other long-term services, such as assisted living or independent living, which differ significantly in service scope and regulatory oversight.

The relationship between these terms reflects an evolution from a primarily custodial perspective to a multifaceted model addressing acute and chronic needs through specialized units. However, despite terminology changes, some stigma persists, rooted in the historical view of nursing homes as places of last resort. This stigma can influence perceptions of care quality, affecting policy decisions, funding allocations, and individual choices.

Historical Development of Nursing Facilities

Nursing facilities emerged largely in response to unmet healthcare needs among aging and chronically ill populations, driven by medical advances, increasing life expectancy, and societal shifts toward deinstitutionalization (Kane et al., 2012). Early 20th-century developments included the establishment of charitable and government-funded homes, evolving into regulated, licensed facilities by mid-century.

The development of nursing facilities has been influenced by legislative acts such as the Social Security Act (1935) and the Nursing Home Reform Act (1987) in the United States, which introduced standards for licensing, safety, and quality (CMS, 2020). The growing emphasis on rehabilitative services, person-centered care, and technological advancements contributed to their transformation into multipurpose health care environments.

Consequences of Terminology Change and Future Impact

The adoption of "nursing facility" over "nursing home" has contributed positively by promoting a more health-oriented image, potentially fostering better funding and regulatory scrutiny. It encourages a shift toward treating residents as active participants in their care, promoting recovery and independence.

Looking ahead, maintaining this terminology and conceptual shift may improve the quality of care by emphasizing health, rehabilitation, and patient engagement. However, the persistence of negative stereotypes and resource constraints could limit these benefits. As demographics increasingly favor more complex care needs, nursing facilities will need to adapt by incorporating advanced clinical capabilities, technology, and personalized care approaches (Hawes & Phillips, 2016).

Future Changes in Nursing Homes

Anticipated future changes include integrating technological innovations such as telemedicine, electronic health records, and remote monitoring systems to enhance care efficiency and safety. Facilities are also expected to adopt models emphasizing wellness, preventive care, and community integration (Harrington et al., 2018). The trend toward person-centered care is likely to intensify, focusing on residents' preferences, independence, and quality of life.

The demographic shift toward an increasingly diverse and older population necessitates adapting facilities to meet varying needs—culturally competent care, specialized units for dementia, and support for frail elders. Policy reforms may promote more funding for these initiatives, fostering quality improvements and innovation.

Subacute Units and Their Emergence

Subacute units are specialized care units within hospitals or nursing facilities designed to provide intermediate or transitional care for patients with complex medical needs that do not require acute hospital-level interventions but exceed routine long-term care (Khosrowshahi et al., 2021). Their emergence stems from the need to bridge the gap between acute hospital care and traditional long-term care, facilitating recovery, rehabilitation, and prevention of readmission.

Subacute care emerged during the late 20th century as healthcare systems recognized the importance of continuing skilled care outside traditional inpatient hospital settings. It allows for more efficient resource utilization, reduces hospital overcrowding, and tailors care to patients with varying acuity levels—ranging from post-surgical rehabilitation to complex chronic disease management.

Strengths and Limitations of Subacute Care

The strengths of subacute care include its capacity to deliver specialized, high-quality care to patients with complex needs, thus reducing hospital stays and avoiding costly readmissions. For example, post-stroke or post-surgical patients benefit from targeted rehabilitation, accelerating recovery (Harrington, 2017). This model can improve patient satisfaction, functional outcomes, and overall throughput in healthcare systems.

However, limitations include potential fragmentation of care, inconsistent standards across facilities, and questions about funding and staffing adequacy. Skilled staffing is crucial but often challenging due to workforce shortages in specialized inpatient and outpatient settings. Moreover, subacute care's integration into existing care continuum poses challenges related to coordination, infrastructure, and ensuring seamless communication between hospitals, subacute units, and long-term care providers.

Impact on Cost and Quality of Care

Subacute care has demonstrated promise in reducing overall healthcare costs by preventing unnecessary hospital readmissions, decreasing length of stay, and promoting faster recovery (Harrington et al., 2018). It improves quality by enabling personalized, goal-oriented care plans, thereby enhancing patient outcomes and satisfaction. Nevertheless, when poorly managed, it can lead to increased costs due to infrastructure duplication or underutilization.

In addition, the emphasis on clinical expertise in subacute units ensures a higher standard of care, particularly for complex cases. Proper regulation and quality assurance are essential to maximize benefits and minimize risks associated with this emerging service model.

Subacute Care: Hospital or Long-term Care System?

Determining whether subacute care should be an integral component of hospitals or long-term care systems depends on healthcare infrastructure and patient needs. Many experts argue that subacute care functions best as a hybrid, embedded within hospitals to leverage acute resources for stabilization and specialist input, while also integrating with long-term care for ongoing rehabilitation and chronic disease management (Bauman et al., 2020).

Embedding subacute units in hospitals facilitates access to advanced diagnostics and emergency services, whereas positioning them within long-term care allows for continuity and holistic management of chronic conditions. Policy and funding frameworks should support both configurations, fostering seamless transitions and reducing gaps in care.

Comparison of Nursing Homes and Subacute Care

Funding models for nursing homes generally involve a combination of Medicare, Medicaid, private pay, and insurance reimbursements, with significant federal and state regulation guiding standards and quality (CMS, 2020). Staffing in nursing homes includes Licensed Practical Nurses (LPNs), Registered Nurses (RNs), Certified Nursing Assistants (CNAs), and administrative personnel, often facing shortages and high turnover.

In contrast, subacute units are typically funded via hospital budgets, Medicare, and private payers, with highly specialized staffing including physical therapists, occupational therapists, and physicians. Regulation is often more stringent due to clinical complexity, requiring compliance with specific safety and quality standards (Khosrowshahi et al., 2021). Marketing strategies for nursing homes emphasize care quality and amenities, whereas subacute units focus on clinical expertise and recovery outcomes.

Both sectors face ongoing regulatory updates aimed at improving accountability and patient safety. Their marketing approaches reflect their distinct roles—nursing homes emphasizing comfort and safety, and subacute units highlighting clinical excellence and rehabilitation success.

Conclusion

The evolving terminology from "nursing home" to "nursing facility" signifies a paradigm shift toward a health-centered approach, emphasizing quality, rehabilitation, and patient-centered care. The development of subacute units responds to increasing complexity within the care spectrum, providing critical bridging services that reduce hospital stays and improve patient outcomes. Both models face challenges regarding funding, staffing, and regulation but also present opportunities for innovation and improved quality.

Future trends point to greater integration, technological adoption, and personalized care approaches. The choice of embedding subacute care within hospitals or long-term care systems should be guided by patient needs, resource availability, and policy frameworks. Collectively, these developments aim to enhance care delivery, reduce costs, and improve the quality of life for aging populations.

References

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