Intermediate Care Facility (ICF)

An intermediate care facility (ICF) is a health care facility for individuals who are disabled, elderly, or not acutely ill, and who require less intensive care than that of a hospital or skilled nursing facility (SNF). These facilities, sometimes known as subacute facilities, are used extensively both by the managed care companies as well as by hospitals to assure that the care is at the most appropriate level for patient needs. A subacute facility may be housed in a SNF or a hospital but is separated for both reimbursement and level and intensity of care.

In recent years the ICF or subacute facility began cropping up when health care benefits began to be “cut back” on what was covered in the hospital as well as in the home. In the 1980s and early 1990s home care for IV therapy for antibiotics and pain management was an accepted practice and was provided in both venues. When the costs of health care continued to escalate, the federal government began to limit coverage for these “nonacute” services in the hospital. At the same time, coverage for IV antibiotics in the home was no longer available. The need for health care in an alternate setting addressing these issues was identified. In addition, many seniors and other individuals with disabilities did not fit the Medicare/Medicaid requirements for acute rehabilitation. That is not to say that they did not require physical, occupational, or speech therapy, but rather that they were not able to tolerate the vigorous three hours of therapy each day. The ICF was the ideal facility for these types of patients and filled the need.

As you might imagine, the ICF requires less staff at all levels. In the acute care setting you may need one RN with specialized training for every two patients in the intensive care setting (per shift) and perhaps one RN for every eight[Page 301] patients per shift in other areas. The support staff, clinical assistants (nurse assistants), and unit clerks (unit secretary) as well as transporters and others are also needed to take care of the patients in acute care. These staffing levels must be maintained whether or not the hospital is at a predetermined occupancy level. Hospitals are expected to provide the full range of services, including acute rehabilitation services, and therefore are required to have a full complement of physical, occupational, and speech therapy for the patient.

These services must be provided until the patient is transferred to another facility. In the ICF the ratio for patients is significantly less. The patient does not require the same surveillance by an RN, nor does the patient require the same intensity of physical, occupational, and speech therapies. The requirement for these therapies in an ICF is that the patient be able to tolerate as little as one or two hours a day.

In the acute rehabilitation setting, the patient is on a fast-paced and intensive program, which must be a minimum of three hours a day. Managed care companies offer this extended care in ICF as part of their benefit package. The companies request concurrent reviews from the utilization review departments in the hospital and then make a determination as to when acute care stops and subacute care begins. It is at this decision point that the patient is prepared to transfer to one of the covered facilities for the required care. Discharge planning takes place throughout the patient’s stay from day of admission. These activities, as well as the concurrent reviews, make the identification and transition smooth for the patient and the family.

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