What are the qualifications for Long-Term Acute Care (LTAC) placement?

From the Guidelines

Long-Term Acute Care (LTAC) placement requires patients to have multiple chronic conditions and need hospital-level care for an average of ≥25 days.

Qualifications for LTAC Placement

The main qualifications for LTAC placement are:

• Multiple chronic conditions: Patients must have complex medical needs resulting from a combination of acute and chronic conditions, such as ventilator-dependent care or pain management 1.
• Average length of stay of ≥25 days: Facilities must demonstrate an average length of stay of at least 25 days to provide extended medical and rehabilitative care to patients with complex medical needs 1.

Comparison with Other Care Settings

LTAC hospitals provide care to a relatively small but growing minority of patients, and are distinct from other care settings, such as:

• Inpatient rehabilitation facilities: require close medical supervision and ability to participate in at least 3 hours of therapy per day, 5 days a week 1.
• Skilled nursing facilities: require skilled nursing care and ability to participate in therapy for less than 3 hours a day, up to 5 days a week 1.
• Home health agencies: require patients to be homebound except for medical appointments 1.

From the Research

Qualifications for Long-Term Acute Care (LTAC) Placement

The qualifications for LTAC placement are not explicitly stated in the provided studies, but the characteristics of patients who are typically admitted to LTAC hospitals can be inferred.

• Patients who are ventilator-dependent 2, 3, 4
• Patients who require inpatient dialysis 2
• Patients with multi-organ or multi-system failure 2
• Patients with postsurgical or organ transplant complications 2
• Patients with complex wounds that need care 2
• Patients with traumatic or acquired brain injury 2
• Patients who have been hospitalized for a prolonged period and require extended complex post-acute care 5
• Patients who are unable to return home after hospitalization in acute care 6

Average Length of Stay

The average length of stay in an LTAC hospital is greater than 25 days, as defined by Medicare 6, 3.

Patient Outcomes

The outcomes of patients admitted to LTAC hospitals are generally poor, with high mortality rates and significant functional impairment 5, 4.

• Median survival after LTAC admission is approximately 8 months 5
• 1- and 5-year survival rates are 45% and 18%, respectively 5
• More than one-third of patients die in an inpatient setting, never returning home after LTAC admission 5