Subacute and non-acute care
Subacute care is defined as specialised multidisciplinary care in which the primary need for care is optimisation of the patient’s functioning and quality of life. A person’s functioning may relate to their whole body or a body part, the whole person, or the whole person in a social context, and to impairment of a body function or structure, activity limitation and/or participation restriction.
Subacute care is comprised of the rehabilitation, palliative, geriatric evaluation and management and psychogeriatric care types.
Non-acute (or maintenance) care is care in which the primary clinical purpose or treatment goal is support for a patient with impairment, activity limitation or participation restriction due to a health condition. Patients with a care type of maintenance care often require care over an indefinite period.
Rehabilitation
Rehabilitation is a form of subacute care in which the primary clinical purpose or treatment goal is improvement in the functioning of a patient with an impairment, activity limitation or participation restriction due to a health condition. The patient will be capable of actively participating.
Rehabilitation care is always:
- delivered under the management of or informed by a clinician with specialised expertise in rehabilitation
- evidenced by an individualised multidisciplinary management plan which is documented in the patient’s medical record. The plan must include negotiated goals within indicative time frames and a formal assessment of functional ability.
Palliative care
Palliative care is a form of subacute care in which the primary clinical purpose or treatment goal is optimisation of the quality of life of a patient with an active and advanced life-limiting illness. The patient will have complex physical, psychosocial or spiritual needs.
Palliative care is always:
- delivered under the management of or informed by a clinician with specialised expertise in palliative care
- evidenced by an individualised multidisciplinary assessment and management plan which is documented in the patient’s medical record. The plan must consider the physical, psychological, emotional, social and spiritual needs of the patient, as well as include negotiated goals.
Geriatric evaluation and management (GEM)
Geriatric evaluation and management (GEM) is a form of subacute care in which the primary clinical purpose or treatment goal is improvement in the functioning of a patient with an age-related medical condition. Such conditions include incontinence, reduced mobility, cognitive impairment and complex psychosocial problems.
GEM is always:
- delivered under the management of or informed by a clinician with specialised GEM expertise
- evidenced by an individualised multidisciplinary assessment and management plan which is documented in the patient’s medical record. The plan must consider the physical, psychological, emotional and social needs of the patient, as well as include negotiated goals within indicative time frames and a formal assessment of functional ability.
Psychogeriatric care
Psychogeriatric care is a form of subacute care in which the primary clinical purpose or treatment goal is improvement in the functional status, behaviour or quality of life of an older patient with significant psychiatric or behavioural disturbance. Such disturbances may be caused by mental illness, age-related organic brain impairment or a physical condition.
Psychogeriatric care is always:
- delivered under the management of or informed by a clinician with specialised expertise in psychogeriatric care
- evidenced by an individualised multidisciplinary management plan which is documented in the patient’s medical record. The plan must consider the physical, psychological, emotional and social needs of the patient, as well as include negotiated goals within indicative time frames and a formal assessment of functional ability.
Where the primary focus of care is acute system control, psychogeriatric care is inapplicable.
Maintenance care
Maintenance care is a form of non-acute care in which the primary clinical purpose or treatment goal is support for a patient with an impairment, activity limitation or participation restriction due to a health condition.
Following assessment or treatment, the patient does not require further complex assessment or stabilisation, but may require care over an indefinite period.
Australian National Subacute and Non-Acute Patient Classification
Under the National Health Reform Agreement 2011, the Independent Health and Aged Care Pricing Authority (IHACPA) is responsible for determining the activity based funding (ABF) system for public hospital subacute and non-acute care services. The classification system used for admitted subacute and non-acute care ABF in Australia is the Australian National Subacute and Non-Acute Patient Classification (AN-SNAP).
AN-SNAP is a casemix classification made up of four subacute care types: rehabilitation, palliative care, geriatric evaluation and management and psychogeriatric care; and one non-acute care type. The classification was developed in 1997 by the Centre for Health Service Development, University of Wollongong, and has been refined four times since then. IHACPA has used AN-SNAP to price subacute and non-acute care since July 2013. The current version, AN-SNAP Version 4.0, was released in May 2015 and has been used to price subacute and non-acute services from 1 July 2016.
In addition to being the classification system for Australian subacute ABF hospital funding, AN-SNAP is also used for clinical management and other purposes such as benchmarking, epidemiological studies, safety and quality monitoring, and research to understand practice and cost variation.
AN-SNAP Version 5.0
In December 2021, IHACPA released the Australian National Subacute and Non-Acute Patient Classification Version 5.0. Further information on IHACPA’s development of the classification is available in the Final Report, and guidance on its application is available in the associated Classification Manual.
This followed a three-year process of detailed statistical analysis of public hospital activity and cost data, as well as consultation with jurisdictions, clinical experts and other subacute care stakeholders.