Post-acute care is defined as rehabilitative and/or palliative care services that a patient would receive after an acute illness or hospitalization. If unable to care for themselves independently, patients may require assistance with their activities of daily living before they can transition back into their home setting. This would require a patient to receive post-acute care after being discharged from a hospital.

Post-acute care facilities include skilled nursing facilities, inpatient rehabilitation facilities, long-term care facilities, long-term care hospitals, and nursing homes. The focus of post-acute care is to provide the care needed for patients to reach their optimal level of functioning. This is mainly done through medication management, education, rehabilitation services, and support services.

To enhance patient outcomes, communication and coordination between acute care hospitals and post-acute care facilities must be seamless. Unfortunately, many gaps between theory and practice continue to exist.

At AAPACE, we believe by standardizing healthcare practices and policies as well as providing nurses with the necessary guidance and support, we can bridge this gap and achieve post-acute care excellence.

Recommended areas for improvement within Post-Acute Care

  • Standardization of policies, care, and treatment guidelines.
  • Defined roles for nurses
  • Increased support and resources for nurses
  • The inclusion of patients in their plan of care
  • Implementing systematic improvement plans in PAC facilities
  • Enhanced communication and collaboration between health care facilities
  • Effective communication between administration and staff nurses within a facility