Long-term care hospitals are for individuals with medically complex problems who require hospital-level care for extended periods.

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.

What types of patients and conditions are treated in a long-term care hospital?

Patients with a need for intensive medical care over a period greater than
25 days are typically sent to a long-term care hospital before they are well enough to return home or go to rehab.

What types of services are offered in 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

There are four main steps to selecting a long-term care hospital:

1) 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.

2) 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. followupcare.org allows you to contact providers to verify whether or not they accept your insurance.

3) 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. followupcare.org 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.

4) 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 followupcare.org profiles have pictures and video tours to help you make an informed decision.

Checklist of Things to Consider

Medicare.gov has a list of suggested things to consider when selecting residential rehabilitation facilities:

Basic Information:

• Is the facility Medicare/Medicaid certified?
• Does the facility provide necessary skilled care and special services?
• Is there an available bed?
• Are there visiting hours? What are they?
• Are residents clean and appropriately dressed?

Living Spaces:

• Are there any unpleasant odors?
• Are the facilities clean and well-kept?
• Are the noise levels appropriate?
• What are the restrictions on smoking?
• Is the facility well furnished?
• Is the temperature comfortable?
• Is there good lighting?

Staff:

• Does the staff have good relationships with the residents?
• Do staff members knock on doors before entering?
• Are background checks conducted on staff members?
• Is a full-time registered nurse (RN) available at all times?
• What are the rotations of nurses and staff members working with a given resident?
• Is there a reasonable ratio of staff members to patients?
• Are certified nursing assistants (CNAs) involved with care planning meetings?
• How often is a licensed doctor available?
• How long has the management team worked together?

Residents’ Rooms:

• Are residents allowed to have personal belongings?
• Is there personal storage space?
• Do the rooms have adequate windows and natural light?
• Do residents have access to personal phone and television?
• What is the roommate selection process?
• How much protection is available for personal possessions?

Common Spaces:

• Are exits are clearly marked?
• Are the visiting areas quiet and well-kept?
• Are there appropriate safety features (emergency evacuation plan, smoke detectors, sprinklers, etc.)?
• Are all areas wheelchair accessible?
• Are there handrails and grab bars in common spaces?

Dining and Activities:

• Is there an appropriate variety and choice of foods?
• Are there nutritious snacks?
• Does the facility offer assistance in eating?
• Are a variety of activities offered?
• Are there outdoor areas for residents to use?
• Are there volunteer programs?

Safety and Care:

• Does the facility offer preventative care (flu shots, etc.)?
• Are residents allowed to see their regular doctors?
• How does the facility handle emergency situations?
• Are care planning meetings scheduled with residents and family members?
• Has the facility corrected all deficiencies from last state inspection?