Long-Term Acute Care Hospital (LTACH) Setting

By: Rinki Varindani Desai, MS, CCC-SLP, University of Mississippi Medical Center

Long-term acute care hospitals (LTACHs) are facilities that specialize in the treatment of patients with serious medical conditions that require acute care on an ongoing basis. These patients are typically discharged from intensive care and acute care units but continue to need more care than they would receive in a rehabilitation center, skilled nursing facility, or at home.

Where are LTACHs located?

LTACHs are usually housed within acute care hospitals but function independently. They also may exist as standalone facilities. LTACHs must be licensed independently and have their own governing body.

Which patients get admitted to LTACHs?

LTACHs are unique in their ability to care for chronically critically ill patients who require specialized and aggressive goal-directed care over an extended recovery period. Typical patients have complex critical illnesses, multiple comorbidities, multi-organ system failures, and significant loss of independence following a traditional hospital stay.

The types of patients typically seen in LTAC hospitals include those requiring:

  • Prolonged mechanical ventilation for respiratory failure
  • Intensive respiratory care post-tracheostomies
  • Ongoing dialysis for chronic renal failure
  • Management of multiple medical conditions
  • Pre- and post-organ transplant care
  • Treatment following neurological conditions and/or trauma
  • Post-surgical acute care
  • Multiple IV medications
  • Infection management
  • Complex wound care

The typical LTACH patient is someone with three to six concurrent active diagnoses or someone who has suffered an acute episode on top of chronic illnesses. Under Medicare, the patient must need more than 25 days of hospitalization. LTACH patients stay an average of 25 to 30 days with the goal of optimizing their ability to live independently or to achieve the highest level of wellness possible and then move on to the next level of care

What is the role of the SLP in LTACHs?

SLPs in LTACHs carry out all the traditional responsibilities of clinicians in typical adult medical settings. However, what makes the role of the LTACH SLP unique is the variable range of services provided to a complex patient population.

Since many patients have tracheostomies or are ventilator-dependent, LTACH SLPs evaluate and treat swallowing impairments in these individuals in addition to improving their tolerance for voice prostheses and speaking valves. They work closely with the respiratory therapists (RTs) and physicians (pulmonologists, ENTs, etc.) towards vent weaning and trach decannulation.

LTACH SLPs also work closely with the patient, family, and staff on ways to optimize the patient’s communication either using alternative and augmentative communication (AAC) or language therapy. They play an important role in evaluating and treating cognitive deficits associated with acute conditions such as stroke and brain injuries, commonly seen in a LTAC setting.

An important thing to remember is that most patients in the LTACH are critically ill with a low tolerance for rehabilitation. The goal of the rehab team in this setting is to work with the interdisciplinary medical team to improve the patient’s medical status, to provide therapy to get them ready for intensive rehabilitation, and to facilitate recovery.

Is the LTACH setting right for you?

The workplace for medical SLPs is undergoing rapid changes, compelling clinicians to be flexible and expedient in learning new techniques and procedures under high-productivity demands. There is a new appreciation for multi-skilled, multifunctional, and cross-trained professionals. SLPs who can be independent learners, face conflicting situations, and overcome challenges will be better prepared to succeed in this ever-changing workplace. With the average 25-day length stay for patients, the LTACH setting strikes the perfect balance between diagnostic and therapeutic skills. It is a fantastic place to not just improve your skills as a medical SLP but also to make a difference in the lives of the patients you treat.

Additional resources for SLPs getting started in long-term acute care hospitals can be found here:

https://www.asha.org/slp/healthcare/LTAC/.