Long-term acute care hospitals (LTACH) have become an integral part of the health care continuum since they were established in the USA in 1999. Many elderly patients admitted to intensive care units (ICUs) survive an acute episode of illness but do not recover fully and develop chronic critical illness (CCI). These patients have been stabilized in short-term acute care hospitals with completion of diagnostic workup and transferred to LTACHs. Elderly patients who have CCI form an important group of patients admitted to LTACHs. LTACHs are organized to provide multidisciplinary management that includes complex medical therapies such as ventilator weaning and dialysis, intravenous therapies like total parental nutrition, complex wound care and rehabilitative services, including physical, occupational and speech therapies. Consistent with high disease burden of comorbidities and poor outcome in the subset of patients with CCI, palliative care should become an essential component of the post-acute care continuum (PACC). LTACHs play a pivotal role in transitioning these patients across the PACC. Details regarding the organization of LTACHs, management of patients with special reference to CCI and perspectives for future advances are discussed in this chapter.
Part of the book: Challenges in Elder Care