The American system of health care seems to assume that all individuals will recover from an illness or injury with just a few days' stay in their local hospital. However, individuals with chronic conditions, and especially the elderly, often require a longer period of recuperation. In fact, some will not make full recovery after an illness or accident. What happens then?

Actually, there are a number of choices that these individuals can consider. The right choice depends upon the individual's specific medical, nursing and functional needs. The choices, and their descriptions here, should help determine the appropriate care setting.

Subacute Care
Subacute care is post-hospital, often post-surgery, care that is more intensive than skilled nursing care, but less intensive than hospital care. Subacute care is for patients who continue to need intravenous therapy, ventilator or tracheostomy care, or treatment of extensive wounds. It is also for patients who require extensive rehabilitation but have complicating medical conditions.

Patients who need subacute care require frequent and around-the-clock monitoring by a licensed nurse. These patients also need frequent review of their regimen of care by their physician, often one or more times a week.

Skilled Nursing Care
Skilled nursing facilities (SNFs) are for patients whose condition requires around-the-clock oversight and treatment that can only be given by licensed nurses. SNFs provide rehabilitation and nursing care for patients who require short-term recovery following an acute illness or accident. Skilled nursing facilities also are for patients who may be bedfast, or who require treatment of chronic conditions as well as assistance with the activities of daily living for extended periods of time.

The care at a skilled nursing facility is typically provided by an interdisciplinary team of licensed nurses, nursing assistants, rehabilitation therapists, dietitians, social workers and activities therapists.

Residential Living Choices: Assisted Living
Assisted living should be considered for individuals who do not require 24-hour nursing care, but who might benefit from some structure in their living environment, some protective oversight and assistance with the activities of daily living.

In some locales, this level of care may be called residential care, catered living or sheltered care. Providers of this level of care may offer a wide array of services, but in general they offer meals, some oversight of medication administration, planned activities, apartment maintenance, laundry and housekeeping services. Many offer assistance with bathing or other functional limitations, and transportation to appointments.

Residential Living Choices: Retirement Communities or Continuing Care Retirement Communities
Retirement communities or continuing care retirement communities (CCRCs) offer independent housing options, such as apartments or cottages, with an array of services, such as maintenance, housekeeping, laundry and security. Central recreation areas, planned activities and meals in a restaurant-like atmosphere are usually available.

CCRCs offer more than one level of care on a single campus, such as independent housing, assisted living and skilled nursing. This availability of a variety of care levels is a good choice for individuals who expect their condition will change over a period of time.

Making a Choice
Knowing the fundamentals is a solid beginning to making the right choice of care: subacute, skilled nursing, assisted living or a retirement community. First, try to match the needs of the individual to the level of care and services offered. Next, look at the long-term prognosis for the individual. If progress toward recovery and return home is anticipated, a skilled nursing or subacute facility with a focus on rehabilitative services may be the right choice. If long-term assistance is likely to be needed, consider the more residential environments offered by assisted living or retirement communities.

Remember to consider the stress that can result from relocation, and try to minimize the number of moves that the individual will require. Finally, always try to involve the person needing care, as well as others significant to them, in making this important decision.

BJC Facilities
Barnes-Jewish Extended Care  -- a 120-bed skilled nursing facility in St. Louis County
Eunice Smith Home -- a 62-bed skilled nursing facility adjacent to Alton Memorial Hospital in Illinois
Transitional Care Unit -- at Alton Memorial Hospital, for patients who require short-term skilled nursing care as a transition between acute care, home care or nursing home care
Skilled Nursing (SWING) -- at Missouri Baptist Sullivan Hospital, skilled nursing for patients who still require nursing care or therapies, but not the level of care available through regular hospitalization
Rehabilitation Institute of St. Louis -- a free-standing facility for patients who have been admitted to the hospital specifically for the purpose of rehabilitation for spinal cord injuries, brain injuries, stroke, neuromuscular problems, and bone and joint injuries
Village North Retirement Community and Rehabilitation Center -- independent apartment living with 24-hour medical care when needed, paired with a 60-bed skilled nursing facility