Long-Term Care Hospitals: Wonderful or Waste?

Among the alphabet soup of medical abbreviations, you may have heard of an LTACH and wondered what that was.

Long-term acute care hospitals (LTACH), also known as Long-term Care Hospitals (LTCH) are hospitals specializing in patients who require extended hospitalization. The legal definition of an LTACH is “a hospital that has an average inpatient length of stay of greater than 25 days.”

Patients commonly stay at an LTACH for care when they’re on a ventilator long-term, or when they’re battling more than one condition. Patients with very complicated illnesses that require extended hospital stays are also referred to LTACHs. Very often, their families are told they can get much better care at an LTACH than at a short-term hospital or long-term skilled nursing facility.

But is that really true?

There isn’t a lot of evidence supporting better outcomes for LTACHs. In fact, new research suggests the opposite.

The study, authored by a team from Standford, MIT, and University of Chicago respectively, found that “substitution to LTCHs leaves patients unaffected or worse off on all measurable dimensions.” The study also suggested that Medicare could save 4.6 billion dollars a year by reimbursing long-term hospitals at the same levels as skilled nursing facilities.

In fact, their data showed that LTACHs didn’t produce statistically significant declines in patient mortality over a 90-day period, nor did they improve the odds that a resident would eventually return home.

Most of the services offered at a long-term acute care hospital can also be received at a skilled nursing facility like Regency Nursing and Rehabilitation. At Regency, we offer all skilled nursing services, including IV and oxygen therapy.

Some individuals, such as some ventilator-dependent patients, may require extended acute care. But according to this study, most patients—and Medicare—may be better off with skilled nursing.

Skilled Nursing Facilities – Proper Care and Discharge Planning

At Regency Park Nursing and Rehab Centers, our dedicated teams of social workers are acutely aware of our responsibility with respect to proper care planning and discharge planning.

In fact, a great emphasis is placed on contacting families immediately upon admission, to invite them to the facility for a comprehensive care plan meeting. At the meeting, which is attended by our therapists, nurses and social workers, there is a discussion of goals and objectives for each individual patient and we collaborate with the family to devise an efficient care plan to result in a safe discharge.

I am extremely invested in this crucial dynamic and indeed so is the Office of The Inspector General.

In fact, in a scathing report just released last month, they document that “skilled nursing facilities often fail to meet care planning and discharge planning requirements.”

Spotlight on Nursing Facilities
Spotlight on Nursing Facilities

They (not so tactfully) invoke the $5.1 billion dollars that Medicare paid for subpar care, poor care plans and even poorer discharge planning.

Here is what they wrote in part:


We based this study on a medical record review of a stratified simple random sample of SNF stays from 2009. The reviewers determined the extent to which SNFs developed care plans that met Medicare requirements, provided services in accordance with care plans, and planned for beneficiaries’ discharges as required. Reviewers also identified examples of poor quality care.



For 37 percent of stays, SNFs did not develop care plans that met requirements or did not provide services in accordance with care plans. For 31 percent of stays, SNFs did not meet discharge planning requirements. Medicare paid approximately $5.1 billion for stays in which SNFs did not meet these quality-of-care requirements. Additionally, reviewers found examples of poor quality care related to wound care, medication management, and therapy. These findings raise concerns about what Medicare is paying for. They also demonstrate that SNF oversight needs to be strengthened to ensure that SNFs perform appropriate care planning and discharge planning.


We recommend that the Centers for Medicare & Medicaid Services (CMS): (1) strengthen the regulations on care planning and discharge planning, (2) provide guidance to SNFs to improve care planning and discharge planning, (3) increase surveyor efforts to identify SNFs that do not meet care planning and discharge planning requirements and to hold these SNFs accountable, (4) link payments to meeting quality-of-care requirements, and (5) follow up on the SNFs that failed to meet care planning and discharge planning requirements or that provided poor quality care. CMS concurred with all five of our recommendations.

Read the entire report, here.