Nursing Levels of Care

Health care has changed in many ways. At one time, most of one's health care was delivered in a visit to the doctor's office or in a hospital. With the expansion of managed care, people now receive care in many different places depending on what they need and what their insurance covers. The Department of Care Coordination has prepared this site to help you and your family better understand the different places where you can receive care. These are generally referred to as levels of care in your health insurance policy.

Doctor's Office or Hospital Clinic

  • This is where you would receive outpatient care or ambulatory care.
  • It usually means you have an appointment with a doctor (primary care physician or internist, specialist like an orthopedic surgeon or cardiologist, a nurse practitioner or a physician assistant.)
  • At this type of visit you would have a physical exam, and then have medications, tests or procedures ordered for you, if needed.
  • Of course, you might be healthy and require no treatment as a result of this visit.

Emergency Department Care

  • This is where you would go if you need emergency care. This includes situations where there is a sudden change in how you are feeling. You might be experiencing chest pain, difficulty breathing, have had an accident, fall or experience confusion.
  • Many Emergency Departments have a system for taking care of people who walk in with minor health problems especially during the evening and night.
  • You will receive treatment and then be sent home or be admitted to the hospital or observation care.
  • Call your primary care physician before you go to an emergency department. Charges for this type of care can be very expensive if your insurance does not cover visits for minor health problems and/or requires PCP approval prior to your ED visit.

Observation Care

  • When you have a doctor's visit, go to an emergency department, or have a procedure, you might require care for a longer period than expected.
  • You may be admitted to "observation care" which can be on a unit in a hospital or might be a special area of an emergency department.
  • Usually patients use this type of care for less than 24 hours.

Acute Hospital Care

  • This is when you require treatment after a surgical procedure or might require special diagnostic procedures and treatments for a medical condition.
  • The care might involve special monitoring, intravenous medications, blood tests, x-rays or procedures.
  • You could be in an intensive care unit or on a general care unit.
  • Physicians or specialists might see you several times a day.
  • The usual time spent in a hospital depends on your diagnosis and treatment or recovery from a surgical procedure.
  • You will be discharged with approval from your attending physician or surgeon.

Specialty Hospital

  • You may transfer to this specialty hospital when you require acute hospital care for an extended period of time. You may be stable enough to leave the acute hospital but still have complex care needs.
  • You usually require a breathing machine (ventilator) and need a long time before the breathing machine can be discontinued.
  • You can receive physical therapy to get your strength back and other acute care treatments.
  • Physicians are available to monitor you twenty-four hours a day.

Acute Rehabilitation Hospital

  • A rehabilitation hospital is recommended when patients are medically stable and need assistance with recovery after a surgical procedure, injury or illness.
  • You must be able to take part in three hours of rehabilitation care each day. This means that you would require physical therapy, speech therapy or occupational therapy. You would need assistance with activities of daily living such as bathing, walking, and cooking.
  • The physician in the acute hospital decides that you are stable to be transferred. While you may be stable, your treatment may be complex and require that a physician is available to see you every day.
  • Patients stay at this type of hospital from 1 to 6 weeks.
  • The insurance company needs to approve a transfer to this level of care.

Subacute Rehabilitation/Skilled Nursing Facilities

  • At this level of care, patients receive assistance with wound care, intravenous medications, physical therapy, occupational therapy or speech therapy.
  • You can be admitted to this level of care from your doctor's office, emergency department or a hospital. You would usually spend from 1 to 10 weeks at this level of care.
  • Facilities that provide this type of care might be special units at nursing homes or transitional care units at an acute hospital.
  • Therapy can be given from one hour up to three hours, if needed.
  • The insurance company needs to approve a transfer to this level of care.

Nursing Home Care

  • Long term nursing homes are for people whose needs for care can no longer be met in their home. It is sometimes called custodial care.
  • Nursing homes often provide different levels of care within the same facility. Patients with comparable needs are placed in the same area. For example, you might only need help with your medication or assistance with bathing or eating and would be in an area with people who have similar needs. If you need more care, you may be placed in a different area.
  • They are supervised by professional and unlicensed nursing staff who are present 24 hours a day, 7 days a week. Physicians are usually called in if needed.
  • Health care insurance does not pay for this type of care. You would need to have long term care insurance, pay privately, or some Medicaid programs cover this level.

Levels of Care for Patients Living at Home

Day Care Programs

  • This level of care is used to help patients with some disability to remain in their own home as long as possible. Patients who have had strokes or have changes in their memory benefit a great deal from these programs.
  • Day care programs involve going to a certain location outside your home during the day, a few times a week. Patients would return to home at night to have dinner and sleep.
  • Some programs offer transportation. Elder Services in your city or town can give you information on programs in your local area.
  • You would need to privately pay or some Medicaid programs would pay for this type of program.

Home Care

  • This level of care is given in your home when you are recovering from an illness or surgery.
  • A visiting nurse or therapist comes to your home for treatment or teaching. You might require intravenous medications, respiratory equipment like oxygen, or a hospital bed.
  • In most instances, your insurance needs to approve this type of care. Most policies require that you are "homebound" which means that you are not able to leave your home for care at a clinic or doctor's office.

Respite Care

  • Family members or friends can use this type of care when they have been providing care at home to another person.
  • This allows the caregiver to take a vacation or address medical needs that the caregiver has.
  • Respite care can be provided in the home or in a nursing home.
  • Most health insurance plans do not provide coverage for respite care. It is usually privately paid.

Hospice Care

  • This level of care is available for patients who are near the end of life.
  • Hospice can provide nursing care, pain control, spiritual or emotional counseling, and symptom management.
  • Usually, a patient remains in their home and their family and friends care for them. Sometimes, a patient cannot remain in their home and may be admitted to a palliative care unit or a skilled nursing home to receive hospice care.

It is generally best for all patients to have a primary care physician who knows you and can help guide the decision making about the level of care you need. Please ask us questions.

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