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Selecting the appropriate post-acute care (PAC) setting for a patient leaving the ICU is a key component of improving outcomes and reducing readmissions. This makes understanding the differences between PAC options essential.

While long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs) are often misunderstood as fulfilling the same role, they exist to care for patients with different admitting conditions and severities of illness.

Learn more about these distinct patient populations and how to determine when a patient may need LTACH care.

Top Patient Conditions

Long-term acute care hospitals provide physician-led acute care for critically ill patients with multiple serious conditions and specialize in treating complex pulmonary diagnoses.

Skilled nursing facilities are lower-level care settings that care for patients with a wide range of conditions that can be managed by nursing staff.

Top Five Conditions by Setting

LTACHs¹

1. Pulmonary edema and respiratory failure
2. Respiratory system diagnosis with ventilator for 96+ hours
3. Septicemia without ventilator support 96+ hours with major complication or comorbidity
4. Respiratory system diagnosis with ventilator support ≤96 hours
5. Respiratory infections and inflammations with major complication or comorbidity

SNFs²

1. COVID-19
2. Urinary tract infection, site not specified
3. Metabolic encephalopathy
4. Sepsis, unspecified organism
5. Encounter for other orthopedic aftercare

Within the Top Patient Conditions at LTACHs:

• More than 25% of cases require ventilator support
• Over 40% of LTACH cases are characterized by the top two DRGs:
  • Pulmonary edema and respiratory failure
  • Respiratory system diagnosis with ventilator support 96+ hours
• Renal failure requiring dialysis is one of the top 10 conditions
• 16 of the top 20 cases include at least one major complication or comorbidity

Severity of Illness

Additional insight into patient differences in each setting can be gained by looking at the Severity of Illness (SOI) Index for patients discharging to LTACHs and SNFs.  The SOI Index was developed to add further clarity to the condition of a patient as defined by APR-DRGs.³ This system assigns a severity level of 1-4 (“minor” to “extreme”) based on factors such as stage of the principal diagnosis, dependency on hospital staff, and extent of non-operating-room life support procedures.

While only 17% of patients discharged to a SNF are those with an “extreme” severity of illness, these patients make up 55% of the population transitioning to an LTACH.⁴

This suggests that even where conditions treated may overlap between settings, LTACHs have unique expertise in addressing cases of greater severity.

How Kindred Hospitals Can Help

Acute care providers need partners who can offer physician-directed care that medically complex patients require.

For over 30 years, Kindred Hospitals have provided focused care for chronically, critically ill patients. With disease-specific certification from The Joint Commission in Respiratory Failure, Kindred specializes in treating patients with complex pulmonary conditions. Additionally, the Move Early program helps patients start rehabilitation as soon as possible, even while on the ventilator.

If you have a medically complex patient in need of acute care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. Our Clinical Liaison team will help you determine whether an LTACH stay is appropriate for your patient. If you are unsure of who your Kindred representative is, please feel free to contact us via recoveratkindred.com and speak with a Registered Nurse who can assist.

References

1. https://www.medpac.gov/wp-content/uploads/2022/03/Mar22_MedPAC_ReportToCongress_v3_SEC.pdf
2. https://www.definitivehc.com/resources/healthcare-insights/top-snf-diagnoses
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195109/
4. https://www.aha.org/system/files/media/file/2019/04/fact-sheet-ltch-0319.pdf