Long-Term Acute Care Hospitals (LTACHs) Resource Guide
Long-term acute care hospitals (LTACHs) are crucial in the healthcare continuum. These facilities provide specialized care for patients with complex medical conditions requiring extended hospitalization as they cannot return to their homes or nursing homes. Countless opportunities exist for nurses to work in LTACHs nationwide and to use their nursing skills in these settings.
As a nurse, understanding the ins and outs of LTACHs can enhance your ability to provide quality care. If you're a nursing student or a nurse currently working in another specialty and are considering working in a long-term acute care hospital, this ultimate guide will provide you with information as you make your decision. Keep reading to learn more about the definition of LTACHs, the typical conditions of patients in these facilities, the pros and cons of working as a nurse in an LTACH, the roles and responsibilities of nurses working in this specialty, and more.
What Does LTACH Mean in Medical Terms?
Long-term acute care hospitals (LTACHs) are facilities designed to care for patients with severe, chronic, or complex medical conditions. The LTACH medical abbreviation describes hospitals that offer extended stays focused on providing intensive, specialized treatment and rehabilitation.
LTACHs often have intensive care units (ICUs) for critical patients and diagnostic areas, such as X-ray rooms, within these facilities. Services provided in LTACHs include pain management, respiratory therapy, head trauma treatment, and more.
Medicare requires that a patient be released to a long-term acute care hospital for additional care if they spend more than 96 hours on a ventilator or more than three days in the ICU. Typically, LTACHs accept various types of insurance, such as Medi-Cal, Medicare, State Children's Health Insurance Program (SCHIP), and Medicaid.
A patient may need long-term acute care when they require additional time healing in a hospital setting, when they have two or more health issues that need attention daily from a physician, or when they have received treatment in an ICU. An average stay in these facilities is approximately 30 days, and under Medicare, a patient must need more than 25 days of hospitalization to stay in an LTACH.
The history of LTACHs dates back to the 1980s when these facilities were created to discharge medically complex patients promptly from acute care hospitals, which would decrease Medicare spending.
What Is LTAC?
The term long-term acute care, known by the abbreviation LTAC, is often used interchangeably with long-term acute care hospital. For critically ill patients, an LTAC facility can provide the same level of care as an acute care hospital or a hospital's emergency department. LTAC nursing is synonymous with LTACH nursing. Later in this blog post, we'll review the responsibilities of these nurses, the soft skills required in this position, and the pros and cons of LTAC nursing.
LTAC facilities have a variety of medical equipment, which may include the following:
- ICU beds
- Respiratory ventilators
- Ultrasound machines
- Vital signs monitors
- Electrocardiogram (ECG) machines
- Sequential compression devices
- Infusion pumps and enteral feeding pumps
- Cannulas
- Endotracheal tubes
- Laryngeal mask airways
- Saturation monitors
- Central venous catheters and indwelling urinary catheters
A Snapshot: Long-Term Acute Care in the US
The number of long-term acute care hospitals in the United States increased by approximately 9 percent annually between 1997 and 2006. What does this mean for nurses? An increase in LTACH facilities signals rapidly growing opportunities for finding LTACH nursing jobs. As patient demands increase, facilities seek more nurses to provide highly skilled long-term acute care.
Across the US, long-term care hospitals are unevenly distributed, with one-third of these hospitals in Louisiana, Massachusetts, and Texas. Nurses in these states, or willing to relocate to them, will more readily find opportunities to work in LTACHs. Some nurses may wonder, "Is there an LTACH hospital near me?" Numerous online resources exist to help you locate nearby LTACHs, including Medicare's website, which enables users to input their location and search for nearby long-term care facilities.
Patient Profiles in LTACHs
The demographic of patients who receive care in LTACHs varies but includes ventilator-dependent individuals, post-surgical patients with complications, and those recovering from severe injuries. Typically, these patients require support they could receive from a general hospital; however, in many instances, these patients may no longer have any more billable hospital days through their insurance. Since these patients are not well enough to be discharged from the hospital, they are transferred to an LTACH, where they can continue to receive medical support from professional care teams—including highly skilled nurses—as these patients are often in critical conditions.
Long-term acute care hospitals treat patients with a range of conditions, and some have multiple comorbidities, including the following:
- Chronic pulmonary disease
- Cardiac disease
- Neurological disorders (such as Alzheimer's and Parkinson's)
- Post-intensive care syndrome
- Surgery complications
- Chronic kidney failure requiring dialysis
- Respiratory conditions requiring a ventilator
- Infectious diseases
- Complex wound care and burn care
- Multiple chronic conditions
Additionally, studies indicate that LTACH patients have high rates of hospital-acquired infections.
Many LTACH patients have stayed at acute care hospitals for significant periods, such as 20 to 30 days. They may have been treated in ICUs, meaning they have high needs and require specialized care for their complex medical situations.
Differences between LTACHs and Skilled Nursing Facilities (SNFs)
Skilled nursing facilities (SNFs) are licensed and certified facilities that serve patients seeking short-term or long-term skilled nursing and rehabilitative services on a 24-hour basis. Patients often utilize these facilities after their hospital stays. However, they are unlike LTACHs in a variety of ways. LTACHs are licensed as acute care hospitals, while SNFs are licensed as skilled nursing facilities.
SNFs aim to restore function so patients can regain their ability to perform daily activities such as bathing, dressing, walking, or getting in and out of bed.
In LTACHs, patients receive daily bedside visits from physicians and other health professionals, such as those specializing in pulmonology, neurology, or infectious diseases. Nurses collaborate in care teams that develop short and long-term goals for patients.
In SNFs, physicians rarely visit patients, and patients typically visit specialists off-site. In skilled nursing facilities, nurses typically lead in developing patient care plans. Refer to Nursa's Ultimate Guide to Nursing Care Plans (NCPs) to learn more.
While LTACHs provide care to medically critical patients needing specialized equipment and treatment, such as ventilators and dialysis, SNFs provide care to patients who are moderately ill and do not require acute-level care. Due to the varying needs of their patients, LTACHs typically have on-site services such as a lab, pharmacy, radiology, and telemetry. On the other hand, SNFs seek these services for their patients outside their facilities.
While SNFs typically have residential air ventilation systems, LTACHs have infection control standards compliant with the Centers for Medicare and Medicaid Services (CMS). This compliance means LTACHs have hospital-level air ventilation systems and negative pressure isolation rooms, which prevent the spread of contagious bacteria and viruses.
In addition to LTACHs and SNFs, acute rehab facilities assist people who have experienced illness or injury, limiting their abilities to function. These facilities typically provide at least three hours of therapy daily, five days a week.
Responsibilities of Nurses Working in LTACHs
Nurses working in LTACHs are responsible for the overall care of patients. They have a range of responsibilities, including the following:
- Ordering diagnostic tests
- Administering medication and intravenous fluids
- Implementing care plans
- Treating and dressing wounds
- Observing and recording vital signs such as patients' pulse rate, body temperature, blood pressure, and respiration rate
- Assisting physicians, specialists, and other medical professionals with care and treatment management
- Managing patients' symptoms, such as pain and fatigue
- Monitoring patients' general condition and treatment response
- Monitoring patients to asses for potential complications by tracking imaging results, laboratory results, and diagnostic tests
- Supporting and educating patients and their families by explaining diagnoses, treatment options, and side effects
LTACH nurses work with specialists to follow care plans and provide the best possible care to patients. These professionals include the following:
- Physicians
- Physician assistants
- Case managers
- Social workers
- Respiratory therapists
- Occupational therapists
- Physical therapists
- Pharmacists
- Dietitians
- Wound care specialists
Qualities of Nurses Working in LTACHs
Nurses working in LTACHs are essential in providing care for patients to support their recovery. Often, these patients are in critical conditions, requiring that nurses working with them have a range of soft skills, such as the following:
- Communication skills: Nurses need to effectively communicate essential details about the patient's care plan with the team of healthcare professionals and communicate with patients and their families, providing information or resources as needed.
- Teamwork: Since various healthcare professionals working in LTACHs often collaborate on care plans, nurses must have strong teamwork skills to coordinate care and work effectively with other specialists.
- Empathy: Since patients in LTACHs often have complex medical situations and have already had an extended hospital stay, nurses need to show patients and their families compassion by being patient and understanding.
- Work ethic: Working in an LTACH can be demanding as nurses may be required to work long shifts. Patients' conditions can rapidly change, requiring nurses to adapt to new care plans. Nurses with a strong work ethic do best in these situations, as they remain committed to providing the best possible patient care under challenging—and sometimes changing—circumstances.
These additional characteristics can help nurses determine if LTACH nursing fits their personalities well.
Pros and Cons of Working as an LTACH Nurse
As with every nursing specialty, working as a nurse in a long-term acute care hospital has pros and cons.
The pros of working as a nurse in an LTACH include the following:
- Working in a challenging, fast-paced environment: For nurses who thrive in settings where no day is the same, LTACH nursing may be the right specialty, as you'll engage with various patient issues and have the opportunity to learn from diverse medical professionals involved in patients' care plans. You'll get to utilize your full scope of nursing training as an LTACH nurse.
- Developing transferable skills: These skills can be used in various ways in LTACHs. Nurses can work in ICUs or niche into neurology, cardiology, renal, oncology, or other nursing specialties.
- Enjoying job security: As the number of LTAC facilities increases, nurses are in high demand and can enjoy increased job security.
- Supporting patients in critical times: Nurses may find this specialty rewarding as they see patients respond positively to medical care.
Here are some of the cons associated with working in LTAC facilities:
- Experiencing stress: Working in a fast-paced environment with patients in critical conditions can be stressful. In addition, LTACH nursing may involve dealing with mortality and loss regularly, which can result in negative mental health impacts. Nurses also need to learn how to manage burnout.
- Suffering from physical exhaustion: Nurses are required to stand for long periods and help move and lift patients. The physical demands of this position can take a toll on nurses over time.
