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 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 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) 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 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 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 several times since. Recent version release dates and implementation dates are outlined in the table below.
| Classification system | Release date | Implementation date |
|---|---|---|
| AN-SNAP Version 4.0 | April 2015 | 1 July 2016 |
| AN-SNAP Version 5.0 | December 2021 | 1 July 2024 |
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.