Guide to Selecting a Long-Term Care Hospital
What is Post-Acute Care
Post-acute care is all the health-related services that patients receive after, or in some cases instead of, care at the doctor’s office or hospital.
Types of Post-Acute Care
- Home Health Agencies – agencies that send medical professionals to patients’ homes so patients can receive skilled nursing and rehabilitation without going to a hospital or residential facility. Common services provided through home health care are wound care, physical therapy, and injections.
- Skilled Nursing Facilities – short-term residential healthcare locations for patients who no longer need to be in a hospital but require a higher level of medical care than can be provided at home. Common services provided at a skilled nursing facility include physical/occupational rehabilitation, speech and language therapy, and complex wound care.
- Inpatient Rehabilitation Facilities – residential healthcare locations that provide intensive hospital-level care for patients with complex conditions such as spinal cord diseases or traumatic brain injuries. Common services provided through inpatient rehabilitation facilities include physical therapy and stroke rehabilitation.
- Long-Term Care Hospitals – long-term residential locations that offer the same level of round-the-clock care as traditional hospitals or intensive care units, but over a longer period of time (usually a month). Common services provided at long-term care hospitals include ventilator care, intravenous (IV) therapy, and dialysis.
More Details about Long-Term Care Hospitals
The goal of a traditional hospital stay is to diagnose, stabilize, and treat your condition to help you recover as quickly as possible. Often times, when patients have complex medical conditions or specialized medical needs, a quick hospital recovery is not possible. Patients who require hospital-level care for more than 25 days typically transition to a long-term care hospital to receive extended care and rehabilitation before returning to their regular home setting.
Long-term care hospitals, sometimes known as transitional care hospitals, provide extended medical and rehabilitative care to individuals with clinically complex problems who need hospital-level care for extended periods of time. The average length of stay at a long-term care hospital is about 4 weeks.
Long-term care hospitals may be located on the same grounds or within the same building of a traditional acute-care hospital. Since they are certified acute-care hospitals, long-term care hospitals are held to the same accreditation and regulatory standards as traditional hospitals so they provide the same level of care. Long-term care hospitals may also exist as separate stand-alone facilities and some offer outpatient services, such as laboratory or radiology procedures.
Services Provided at a Long-Term Care Hospital
The medical services offered at long-term care hospitals are more individualized and resource-intensive than those provided in a skilled nursing facility, nursing home, or inpatient rehabilitation facility. Patients typically have around-the clock access to physician services.
Some examples of complex conditions that are commonly treated at a long-term care hospital are:
- Neurological or post-trauma conditions (such as stroke, spinal cord, traumatic brain injury, paralysis or dysphagia)
- Conditions requiring mechanical ventilation or ventilator weaning (respiratory and heart failures, emphysema, pneumonia or COPD)
- Complex wound care (such as burns or pressure-related)
- Conditions resulting in organ failure
- Severe infections (such as sepsis or infectious diseases)
Typical services provided at a long-term care hospital include:
- 24-hour nursing care from an all-registered nurse certified staff
- Respiratory care
- Ventilator care
- Complex wound care
- Intravenous antibiotics (IV therapy)
- Physical, occupational and speech therapy
- On-site pharmacy, diagnostic radiology and lab services
- On-site dialysis
Long-Term Care Hospitals vs. Skilled Nursing Facilities
Long-term care hospitals typically provide a higher level of care than skilled nursing facilities and are able to address more complex medical conditions. Some long-term care hospitals even have the capability to perform surgery on site. Additionally, patients receiving care at a long-term care hospital must require at least 25 days stay however there is not length of stay requirement for a skilled nursing facility.
How to Select a Long-Term Care Hospital
Understand Your Medical Needs
Meet with a medical professional to make sure that a long-term care hospital is the best follow up care option for you or your loved one. A long-term care hospital is the best option for patients with complex medical conditions who require hospital level care and intensive rehabilitation for an extended period of time (more than 25 days). If the patient has a complex medical condition but only needs a couple weeks of intensive rehabilitation, an inpatient rehabilitation facility may be a better option. If the patient does not have a complex condition or requires only basic rehabilitative support, a skilled nursing facility may be more appropriate. If the patient does not have any significant medical needs and instead can receive rehabilitation care in the home setting, home health care may be more appropriate. If the patient has a specific medical need (diabetes, chronic disease, wound care, etc.), you can narrow down your search by evaluating facilities based on what specialty care they can provide.
Verify Your Insurance Coverage
When selecting a long-term care hospital, it’s important to consider your payment options and understand what your insurance policy will and will not cover. If your physician determines that care at a long-term care hospital is medically required, most insurance policies, including Medicare and private insurers, will cover at least a component of your stay. For example, if you qualify for Medicare-covered care, your out-of-pocket costs will be similar to an inpatient hospital stay. Remember that each policy is different and it’s important to verify your coverage before making care arrangements. repisodic.com allows you to contact providers to verify whether or not they accept your insurance.
Compare Facilities Based on Quality Measures
Quality measures are strong indicators of the quality and level of care and rehabilitation you will receive at a facility. Different qualities to compare are how many of the residents at a given facility showed marked improvements during their stay, how many were re-hospitalized, how many had a fall that resulted in a major injury, and how many were successfully discharged. repisodic provides these metrics, and more, for each facility and measures them against state and national averages to help put them in context and make the comparison process easier for you.
Visit the Locations (if possible)
If possible, it’s also helpful to visit the location. You can evaluate cleanliness and entertainment options and talk to employees and current residents about their experience. Ask the staff members how different situations are handled and how you or your loved one will fit in at this location. If you’re unable to visit the location, many repisodic profiles have pictures and video tours to help you make an informed decision.
View our checklist of things to consider when selecting a long-term care hospital.
How to Pay for a Long-Term Care Hospital
Because care provided in a long-term care hospital is considered medically necessary, it’s usually covered by health insurance. In general, patients do not pay more for care in a long-term care hospital than in an acute care hospital because it is the same condition that is being treated.
A stay in a long-term care hospital is covered under Medicare, and general you won’t pay more for care in a long-term care hospital than in a normal acute care hospital. As long as you are:
- Transferred to a long-term care hospital directly from an acute care hospital
- Admitted to a long-term care hospital within 60 days of being discharged from an inpatient hospital stay
Insurance coverage in these facilities includes:
- Inpatient hospital services and supplies
- Semi-private room
- Meals
- Nursing
- Medications administered during your inpatient stay
In certain situations, and depending on your condition, coverage could also include:
- Rehabilitation services
- Pain management
- Treatment for head trauma
- Ventilator or respiratory therapy
Coverage under private and commercial insurance plans will be similar to the Medicare policies list above. However please keep in mind that health insurance payment options and programs that cover long-term care hospitals are quite complex and regularly subject to change. A patient’s individual insurance policy determines what post-acute care services are covered and paid for.
We encourage all patients to consult with their insurance company or administrator for final determination of what post-acute care or long-term care hospital services their policy covers.
Download this information as a PDF: Guide to Selecting a Long-Term Care Hospital