Long Term Acute Care

What is Long Term Acute Care? There is a lot of confusion about what an LTAC is and what they do for patients. I hope this helps some people understand the function of LTACs better.

First let me explain what an LTAC is not.

LTACs are not nursing homes.

LTACs are not rehab centers.

LTACs are not assisted living centers.

LTACs ARE acute care hospitals (similar to a regular hospital). They are designed to provide care for the patients who are too fragile or ill to recover in the time allotted by Medicare at a regular hospital. A simple version is that they are the sickest of the chronically ill patients found in any normal hospital.

We provide care for the patients with multiple illnesses that play against each other such as the patient with heart failure who needs to have excess fluid removed from their bodies and is also a kidney patient who is difficult to remove fluid from. The diabetic patient with multiple complications such as heart disease combined with poor circulation in their legs along with open wounds that do not heal. The patient who has been paralyzed for many years and now has multiple wounds, bladder difficulty, infection issues and problems associated with a lifestyle that prohibits physical activity. The patient with lung disease that the regular hospitals cannot get off of a ventilator. The patients with infection in their bones who need complex and long term antibiotic therapy along with complex wound care. These are just some of the typical patients seen in an LTAC on a daily basis.

Our patients are always fragile and it becomes a challenge to provide the best care. Each patient and their care is different, challenging and requires daily review and revision. Nursing becomes critical for these patients in order to provide them with the best chance of healing and returning to their home. (or nursing home).

Our patients are with us for an average of almost 4 weeks. Our staff, our patients and the patients family get to know each other much better than in the typical hospital where the patient only stays an average of 3-5 days. We become attached to most, tolerant of a few and we get to understand almost all of our patients and their families. The emotional rewards of practicing the ART of nursing with our patients are enormous. The feelings of accomplishment when one of our ventilator patients speaks for the first time in weeks cannot be explained. The "warm and fuzzy" feelings when we finally stop wound care on patient whose wounds have been open for over a year are incredible. The wounds are finally closed. Seeing a patient go home that none of us believed would survive is an indescribable sensation. This is why we have chosen to work in an LTAC.

The hardest part of our jobs are the patients who do not respond to treatment. Those who continue to get worse until physicians and nurses can no longer help. We see many more of these patients than the normal nurse. We become closer to them and their families. We cry when they pass.

And yet, I find rewards even when a patient does not survive. I know that we have done everything we could. I feel we have provided some dignity for the patient and the family. I know we often provide comfort, acceptance and closure for the families. Acceptance and closure are frequently impossible to provide in a fast paced Short Term Acute Care hospital. (a normal hospital).

I hope this helps others to understand what an LTAC is and why I find the work so very rewarding after 20 years of working in World Renowned ICUs and ERs.