title: A subacute model of geriatric care for frail older persons: the Tan Tock Seng Hospital experience.
abstract: BACKGROUND
  The subacute care unit in Tan Tock Seng Hospital (TTSH) was set up in May 2009. We examined its impact on the transitions at the nexus between hospital and community sectors, patients' discharge destination and functional performance.
  
  
  METHODS
  We studied patients admitted during the initial 6-month period (May to October 2009). Differences in demographics, length of stay (LOS), comorbidity and severity of illness measures, functional outcomes (modified Barthel Index (MBI)) according to discharge destinations were obtained. We also studied the impact of LOS on the geriatric department and the bill size over the pre- and post-subacute implementation periods.
  
  
  RESULTS
  Majority of the subacute patients' hospital stay was in subacute care. Of these patients, 44.9% were discharged home, 24.2% to a slow stream rehabilitation (SSR) setting and 29.2% to nursing homes. 16.9% consisted of a subgroup of dementia patients requiring further behavioural and functional interventions, of which 50% managed to be discharged home. Functional gains were seen during subacute stay; with greatest gains observed in the SSR group. There were no differences in overall LOS nor total bill size (DRG-adjusted) for the geriatric medicine department during the first 6 months of operating this new subacute model compared with the prior 4-month period.
  
  
  CONCLUSIONS
  We propose this subacute model of geriatric care, which allows right-siting of care and improved functional outcomes. It fulfills the role easing transitions between acute hospital and community sectors. In particular, it provides specialised care to a subgroup of dementia patients with challenging behaviours and is fiscally sound from the wider hospital perspective.
authors.affiliation: Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. mei_sian_chong@ttsh.com.sg
authors.forename: Mei Sian
authors.initials: MS
authors.lastname: Chong
authors.forename: Esmiller F
authors.initials: EF
authors.lastname: Empensando
authors.forename: Yew Yoong
authors.initials: YY
authors.lastname: Ding
authors.forename: Thai Lian
authors.initials: TL
authors.lastname: Tan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006299:Health Services for the Aged; D006305:Health Status Indicators; D006801:Humans; D007902:Length of Stay; D008297:Male; D017146:Models, Organizational; D012189:Retrospective Studies; D012846:Singapore; D016896:Treatment Outcome