What’s Long-Term Acute Care? Definition + Examples

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

You’re not alone if you have never heard of Long-Term Acute Care Hospitals (LTACHs). Most people are familiar with the term long-term care, which applies to any number of care services and resources for people as they age and recover from medical conditions and injury. 

Jump ahead to these sections:

Traditional long-term care refers to home health, assisted living, in-home care, family caregiving, and nursing home care. LTACHs are a specialized care setting for a subset of qualified patients. In the vast majority of cases, your loved one is already in the hospital, and the staff recommends an LTACH based on diagnosis and prognosis of the condition that brought them to the hospital.

What Is Long-Term Acute Care?

LTACHs are hospitals that treat patients with serious medical conditions that no longer need the hospital’s intensive care unit (ICU). A patient goes to an LTACH because their medical needs are so great that they require more help than is available in a rehabilitation center or skilled nursing. 

LTACHs can focus staff time and medical interventions to care for complex patients. LTACHs have the following specialized services:

  • Ventilator and high oxygen flow capability
  • 24-hour nursing and physician services
  • Radiology
  • Dietary services
  • Physical, occupational, respiratory, and speech therapy
  • Pharmacy
  • Wound care
  • IVs
  • Dialysis

An example of when an LTACH is needed is for COVID-19 patients with long-term oxygen needs that no longer require limited ICU space. ICUs are intended for very short-term treatment, and since most hospitals have on average about 21 ICU beds, if someone still has acute needs,  and can be treated in another setting, they are moved to an LTACH. 

What Is the Goal or Purpose of Long-Term Acute Care?

The goal of LTACH is recovery to the extent that the patient can be treated in a less intensive care setting such as a rehabilitation center, home with home health, or hospice. A less intensive setting where a patient can be more independent is the goal. But, studies show that most older adults admitted to LTCHs die within five years and two-thirds end up living their remaining years in acute care. 

Are There Different Types of Long-Term Acute Care?

Strictly speaking, there are not many different types of long-term acute care settings. There can be a misunderstanding of the terms acute care and long-term acute care. You are probably most familiar with acute care settings such as an ICU, an emergency room, or an urgent care setting. Each of these services is short-term, not long-term. There are two types of long-term acute care settings. 

Long term acute care in a regular hospital

Some hospitals, but not all, have a section of the hospital designated as an LTCH. Essentially it is a hospital within a hospital.  Being a patient in a hospital with an LTCH means not having to be transported to another facility.

Freestanding long term acute care

A free-standing long-term acute care hospital is one where all beds are devoted to the needs of long-term acute care patients. A free-standing LTACH must be treated and governed as any other hospital. It must have its own CEO and medical staff, as would any acute care hospital.

Who Typically Uses Long-Term Acute Care?

Most people who suffer a life-threatening or complicated medical event want to recover their function and independence. Sometimes for that to happen, they need a much higher and more intensive level of care. However, often patients in LTACHs do not improve and then must decide whether to continue to live depending on life-saving interventions or whether to continue in an LTACH or go on hospice. 

Long-term acute care hospitals have these benefits or patients who go there:

  • They have the same licensing, accreditation, and certification as hospitals and offer specialized and focused care with a higher staff-to-patient ratio.
  • There is evidence that LTACHs can reduce hospital readmissions.
  • LTACHs treat patients who are sicker and more medically complex. 
  • LTACHs will vary across facilities in terms of quality of care and infection control.

Some of the typical conditions that bring patients to LTACHs:

  • Prolonged ventilator use or high volume oxygen. For some patients, if they need such a high level of oxygen to survive, it can’t be provided in an outpatient setting or at home
  • Ongoing dialysis for chronic renal failure
  • Intensive respiratory care that might include weaning someone off of high volume oxygen
  • Ongoing  IV medications or transfusions
  • Complex wound care or care for burns
  • Medically complex situations like multiple organ failure
  • Support for organ transplants
  • Rehabilitation post-stroke
  • Ventricular Assist Device Support (VAD). (A ventricular assist device is implanted in the body to take over the pumping action of the heart. VADs are for patients who have weakened hearts or heart failure. They are used when waiting for a heart transplant or might be a long-term option.) 
  • Resistant infections

How Do You Pay for Long-Term Acute Care?

Because care in a long-term care hospital (LTACH) is considered medical care, most insurance policies provide some sort of coverage.  

A stay in an LTACH is covered under Medicare and would be paid for as long as you have met your deductible and in some cases require more than 25 days of care. 

The other criteria are:

  • Transferred to an LTACH directly from an acute care hospital
  • Admitted to an LTACH within 60 days of being discharged from an inpatient hospital stay
  • A physician determines an LTACH is necessary
  • The patient cannot be managed at a lower level of care 
  • The facility meets Medicare criteria conditions for participation as an LTACH

Insurance coverage (depending on your policy)  includes:

  • Inpatient hospital services and supplies
  • Physician, imaging, and lab services
  • Semi-private room
  • Meals
  • Nursing
  • Medications administered during your inpatient stay

When coming from a hospital, as most patients do, the discharge planner or nurse case manager will ensure that your insurance covers care in an LTACH.

Tips for Finding the Best Long-Term Acute Care

Finding the best long-term acute care could depend on several factors. The first is that you may not have much time to decide. The second is that you may not have many choices, however, to the extent that you can follow these tips for finding the best long-term acute care.

Physician and nurse case manager recommendations

If your loved one is in intensive care, the attending physician and nurse case manager will have experience dealing with a transition to an LTACH. Consider their expertise but also ask questions about the care.

Visit

If you have time, a visit and some relevant questions should tell you a lot about the quality of care of an LTACH. Consider asking these questions:

  • Ask questions related to the condition that brings your loved one there. For example, if they are on a ventilator, ask about the success rate of weaning patients off of high-volume oxygen.
  • What is the nurse-to-patient ratio?
  • Is physical therapy a standard part of care, and how often can your loved one expect to receive it?
  • What percentage of patients are discharged to a lower level of care?

Location

You won’t want to sacrifice good care for the location, but having access for family members to visit your loved one is important. Part of quality care is family involvement, and if it is challenging for family members to visit, that affects care.

Word of mouth

Friends, neighbors, and other family members may have had experience with a particular LTACH. The other possibility is asking the nurse case manager or social worker at the hospital for the names of other family members who have used a specific facility. 

Alternatives to Long-Term Acute Care

An alternative to long-term acute care will be a challenge depending on your loved one’s condition and the interventions required to keep them alive and safe. For example, if your loved one needs high-volume oxygen, there may be no alternative to an LTACH since home health does not have the capability of providing that level of oxygen. However, there are some alternatives you can consider and try. 

Hospice

Hospice is a reasonable alternative to long-term acute care due to the support and services it can provide.  Although hospice implies that your loved one has given up the hope of recovery, sometimes this is the best choice.  Hospice can allow someone to be at home where they are more comfortable. If your loved one needs to be weaned off of oxygen, hospice can assist with a painless transition. 

If the family requests it, hospice can also use life-extending interventions like a tracheotomy and a feeding tube. The family can also request oxygen for comfort, but hospice can’t provide high-volume oxygen. Pain relief and comfort care at home is the goal and not necessarily recovery.  

Home care

In some cases, home care can offer enough support as an alternative to long-term acute care. Home care can be a combination of time-limited home health and privately paid caregivers. Home care can be provided at your loved one’s home or in assisted living.

Home health can do wound care, respiratory support, manage feeding tubes and mechanical ventilation. But, keep in mind that home health is typically time-limited, so if assistance is needed beyond what home health can provide, the family will need to step in. 

Assisted living

Assisted living will be limited in what kind of medical support they can provide, but they can offer robust and consistent aide service, which could help. Combine assisted living support with home health, home care, private nursing, and/or family support. 

Family care with home care

A combination of family care with home health and home care is a possibility. It is not unusual for family members to learn how to provide complex medical interventions to keep a loved one at home. A high level of family involvement can be stressful, so be prepared and well-trained if you choose this option. 

Long-Term Acute Care 

If your loved one needs long-term acute care it means they have serious and complicated medical issues that require specialized care.  The good news is that this type of care is available, but keep your expectations reasonable. Keep a watchful eye on the care your loved one receives and if appropriate, consider alternatives. While someone is in long-term acute care be thinking about the kind of care they will need when returning home.  


Sources:
  1. Rapaport, Lisa. “Most Long-term Acute Care Hospital Patients Die Within Five Years.” Physician’s Weekly. 26 August 2019. physiciansweekly.com
  2. “What Are Long-Term Care Hospitals? Medicare.gov, 2021. medicare.gov
  3. “Long Term Care Hospitals.” Center for Medicare Advocacy, 2021. medicareadvocacy.org
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