Each year, long-term acute care hospitals (LTACHs) care for over 70,000 individuals with complex and serious illness requiring prolonged inpatient care for weeks or months following a short-stay hospitalization. While LTACHs are most distinct from other post-acute care settings for their expertise in caring for patients with chronic critical illness, three-quarters of the LTACH population are not mechanically ventilated, but have a range of complex medical needs including wound care, intravenous therapies, and dialysis. Patients cared for in LTACHs are typically older, disproportionately from underserved backgrounds (black race and dual Medicare-Medicaid) , and have substantial multimorbidity. Individuals transferred to LTACHs have prognoses similar to patients with metastatic cancer, with a median survival of only 8 months, and often spend most of their remaining life in a hospital or long-term care facility.
Given the substantial morbidity and mortality, including for non-mechanically ventilated patients, most, if not all individuals cared for in LTACHs meet criteria for specialty palliative care consultation, which in other settings has been shown to improve quality of life and end-of-life experiences, decrease burdensome care, and significantly lower costs by reducing unwanted care. Despite these benefits, only about one-third of LTACHs nationwide self-reported having a palliative care program. Moreover, little is known about the structure and characteristics of these programs, including their staffing levels. We also do not know why certain LTACHs lack palliative care programs and how palliative care is delivered in their absence.
We conducted this study to evaluate the scope of palliative care programs and staffing models in LTACHs, to understand differences in characteristics of LTACHs with and without a palliative care program, and perceptions of their leaders regarding the barriers and challenges to starting a program. Understanding these knowledge gaps can help inform optimal design and implementation of palliative care services in LTACHs to care for an extremely at-risk population.
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