Just as there are different kinds of patients, there are different kinds of hospitals. Kindred Transitional Care Hospitals provide a wide range of services to help patients with complex medical issues who need additional recovery time after a stay at a traditional hospital. While every patient receives individualized care from a team of healthcare professionals, our goal is for each person to reach the highest level of recovery before discharge.

With our Direct Admit Program, physicians can admit medically complex patients from short-term acute care hospitals, skilled nursing facilities, home health and other service providers directly to a Kindred Hospital. We work directly with physicians to make sure their patients have a smooth transition into our hospitals and the highest level of care continuity to prevent future readmissions.

When someone suffers a traumatic brain trauma — whether it’s from an automobile accident, severe stroke or other injury — he or she is initially admitted to an Intensive Care Unit. After patients are medically stable, it may be necessary to transfer them to a long-term acute care or transitional care facility before an acute rehabilitation or subacute rehabilitation facility.

According to Terry Eberly, a speech pathologist at Kindred Hospital Denver, two assessment methods are used to determine the extent of the injury and issues that need to be addressed:

Based on the results of the evaluation, a plan is customized to the needs of the individual, encompassing and integrating therapies to treat respiratory, speech, motor, visual, orthopedic and other identified issues.

Kindred’s Transitional Care Hospitals play a vital role in the recovery process for the sickest and most medically complex patients who require aggressive medical care and rehabilitation over a longer period of time. For patients who have complex ventilator needs, multi-organ system failure or complicated medical problems that are very difficult to treat, transitional care hospitals may represent the first important step necessary to make recovery and return home possible.

These hospitals are licensed as general acute hospitals, often featuring such familiar elements as Intensive Care Units (ICUs), operating rooms and on-site laboratory and radiology services, but they also are distinguished by an additional Medicare certification that recognizes the need for extended recovery periods.

Transitional Care Hospitals (TCHs) offer aggressive, medically complex care, intensive care and short-term rehabilitation.

Certified as long-term acute care hospitals and licensed as acute care hospitals, Transitional Care Hospitals are unique in their ability to care for critically ill patients who require specialized and goal-directed care over an extended recovery time. They have an additional Medicare certification that supports a length of stay measured in weeks as compared to the typical five-day stay for patients in traditional hospitals. At Kindred, about two-thirds of our TCH patients have Medicare.

TCH patients require an average length of stay of 25-30 days, and have many co-existing medical conditions, some acute and some chronic. Examples of some of the services TCH patients require are:

Some of the conditions commonly seen in a TCH are:

With February being Heart Month, and knowing that heart disease is one of the readmission penalty diagnoses, I paid attention when I recently read a study in Annals of Internal Medicine from investigator Janet Prvu Bettger and collaborators from Duke and Wake Forest.[i] This study looked at the role of transitional care interventions in patients who had recently suffered a heart attack or stroke. The question was legitimate:  what interventions around transitions work to improve outcomes? What they found was sobering.

An intervention known as noninvasive ventilation is being increasingly studied and used in patients with chronic respiratory failure. An article in a recent issue of the journal Respiratory Care, which followed a national symposium dedicated to the care of the chronically critically ill patient, examined its use in several patient populations. Noninvasive ventilation, or NIV, does not require an artificial airway, in contrast to tracheostomy (surgical creation of an airway through the neck) or the placement of a breathing tube through the nose or mouth. NIV is achieved most often through the delivery of pressure and flow to the normal airway through the nose and/or mouth.

The benefits of NIV therapy include reduced re-hospitalizations of out-patients and a reduction in potential complications such as infection that can occur with invasive ventilation techniques.

October 21-27 is Respiratory Care Week, a week set aside to recognize respiratory therapists for their hard work and dedication. “The respiratory therapists at Kindred provide a wide range of respiratory care to patients with complex respiratory disorders and other extensive medical complexities,” says Kelly Bailey, Area Director of Respiratory Care, Kindred Healthcare. “Our respiratory therapists add value and expertise to the interdisciplinary team through the development, utilization, and implementation of best clinical practices and standardization.”

Chronically critically ill patients, a population whose needs and challenges were the sole subject of a recent issue of the journal Respiratory Care, have a very high mortality rate, and survivors among the group suffer with severe impairments and functional dependence. For the caregivers of these patients, the effect can be devastating. According to one article in the journal, “it is difficult to imagine a group of patients with greater need for high-quality palliative care.”

Graphic depicting the spectrum of palliative care as seen in http://www.slideshare.net/Kindredhealth/palliative-care-across-the-continuum

This article points out that early integration of palliative care for these patients can be highly beneficial, particularly in helping patients and families define goals for care and manage the emotional issues that arise when a patient is chronically critically ill.

Sean R. Muldoon, M.D., M.P.H., F.C.C.P.
Senior Vice President and Chief Medical Officer
Kindred Healthcare Hospital Division

Many important questions were raised by information published in the June 2012 issue of the journal Respiratory Care. This issue followed a national symposium dedicated to the “chronically critically ill patient,” the patient with ongoing costly medical interventions, risk for medical complications and death, and the need for extensive post-acute care services.

Cody, a patient at Kindred Hospital San Gabriel Valley, had great dedication and never gave up on his health.

Cody, a patient at Kindred Hospital San Gabriel Valley, was visiting a cousin’s home when he was found unresponsive and taken by ambulance to a short-term acute care hospital. He was admitted for acute respiratory failure, hypoxia, encephalopathy, acute renal failure, acute hepatitis and rhabdomyolysis.

At the short-term acute care hospital, Cody’s condition was stabilized but he still required high-intensity care. He transferred to Kindred Hospital San Gabriel Valley for continued care including ventilator weaning, respiratory therapy and rehabilitation.