All Long Term Care – or Risk of Liability – Is Not Equal

Recently, while coordinating the admission of a clinically appropriate patient to a long-term acute care hospital following treatment in an intensive care unit, a physician was reluctant to discharge the patient to long-term acute care. The reluctance came from believing that the patient would never achieve ventilator liberation. Unfortunately, this misconception is common. However, ventilator weaning is precisely what would occur in a long-term acute care hospital (LTACH) setting. In fact, the LTACH model of care specifically caters to the post-intensive care needs of critically ill, mechanically ventilated patients with complex needs and multiple serious diagnoses, necessitating collaborative, multi-disciplinary treatment, including hemodialysis, LVAD, and intense, aggressive specialized care and therapy, which cannot be provided in a short-term acute hospital setting.

Extended Intermediary Care

All long-term care is not the same. Although an LTACH is a form of long-term care, it is a medically complex transition from the acute care hospital intensive care or step-down unit to a longer-term, goal-focused, and outcome-directed plan of care for critically ill patients in need of extended recovery. LTACH care aims to provide continued treatment that cannot be offered in a skilled nursing facility or nursing home. Unlike those settings, an LTACH provides 24-hour physician support in addition to the auxiliary laboratory, radiology, telemetry, high acuity, and surgical care provided in a traditional acute care hospital, but on an extended basis. LTACH is the intermediary level of care provided before discharge home for further rehabilitation or a traditional long-term care setting.

The Importance of Interdisciplinary Care

Since the LTACH patient is often medically fragile and complicated, there are increased areas of liability involved in their care, as well. The highly collaborative nature of LTACH treatment means the interdisciplinary care team must work closely to ensure that goals of care are met timely, appropriately, and within the standard of care. While the goals consist of the traditional long-term care objectives of safety, nutrition, and skin integrity, the added complexities of critical illness correlate with an increased risk of liability when those goals remain unmet or are further complicated by ongoing issues. Thus, the collaboration of the interdisciplinary care team remains the core of LTACH care in meeting patient care needs through achieving maximum recovery potential, goal setting, and quality outcome measurement. In the immediate intensive care unit setting, outcomes are measured in shorter terms – minutes, hours, and days. The intensive care unit is a sprint. LTACH treatment, though, is the beginning of the marathon to recovery. Outcomes are measured over weeks and sometimes months, ultimately leading to longer-term recovery at skilled nursing facilities, nursing homes, and at home. The standard of care is the same as in the short-term hospital setting; however, the risk management challenges are more complex.

MLAP understands the risk intricacies involved in all aspects of long-term care, including long-term acute care hospital treatment. Let us share our expertise with you in gaining further insight into the standard of care involved in complex post-intensive care patient needs, ventilator liberation, complicated wound care treatment, and management of multiple critical diagnoses.

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