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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

I’m not sure whether it will be really that quick today but today, I want to talk about an email that we had from a reader who says, “I’m feeling forced by the ICU to send my husband into LTAC (long-term acute care facility) and I don’t want him there neither does he want to go there.” So, I’ve addressed this particular issue many times here on my blog and we have so many clients coming to us, begging us to either avoid transfer from ICU to LTAC or begging us to help their loved ones getting out of LTAC because LTACs are probably not even the better version of a nursing home.

Most LTACs really have no idea what to do with an intensive care patient on ventilation and tracheostomy, and we advise strictly against LTAC. This is obviously for our U.S. audience. LTACs only really exist in the United States.

So, when we have clients come to us and ask us, “What should we be doing to avoid LTAC and not to go there?” Because families always tell us, “Well, ICU told us tomorrow at five o’clock, we’ve got an LTAC bed and tomorrow at five o’clock, your loved one will be transferred to LTAC.” I say, “Well, that is without consent and it’s illegal.”

Now, in order to verify that what I am saying is accurate today, I want to actually read out an article from Cornell Law School that talks about discharge planning in the U.S. ahead.

It says, “Condition of participation: Discharge planning.” I want to actually read that out so you can actually see that what I am saying is accurate.

So, I’ll start with paragraph 482.43. And of course, I will link towards this article on Cornell Law School below my video today so that you can actually find the article for yourself, but I’ll read that out to you.

“The hospital must have an effective discharge planning process that focuses on the patient’s goals and treatment preferences and includes the patient and his or her caregivers/support person(s) as active partners in the discharge planning for post-discharge care. The discharge planning process and the discharge plan must be consistent with the patient’s goals for care and his or her treatment preferences.”

Now again, if a family says, “Well, we don’t want to go to. We want to continue treatment in ICU”, then a transfer to LTAC is simply not aligned with the treatment preferences of a patient or a family. Bear in mind, one of the prerequisites for LTAC is, generally speaking, to have a tracheostomy or a PEG (percutaneous endoscopic gastrostomy). Again, we advise against the PEG tube in particular because there’s no need for a surgical procedure and for PEG tube. Feeds can be given through a nasogastric tube for many months to come if that’s what’s needed. But the focus to stay in ICU is really to get off the ventilator as quickly as possible, which most l have no idea how to go about. You can see that when you google reviews; online reviews, or Facebook reviews, social media reviews for LTACs. Have a look and see for yourself.

“…consistent with the patient’s goals for care and his or her treatment preferences, ensure an effective transition of the patient from hospital to post-discharge care, and reduce the factors leading to preventable hospital readmissions.”

Countless videos I’ve made already where patients go from ICU to LTAC and bounce back to ICU within less than 24 to 72 hours simply because, again, LTACs are not equipped to look after intensive care patients. ICUs are sending patients out prematurely.

Now, it goes from bad to worse when patients do bounce back into ICU, they often bounce back into another ICU because the discharging ICU no longer has that bed available. So, imagine you’re discharging a critically ill patient from ICU to LTAC and then you’re going back to another ICU within less than 24, or 48, 72 hours. That means a critically ill patient has been to three different facilities within less than 72 hours. That is madness. That is absolute madness and it’s negligent. A critically ill patient needs a stable team around them not being moved from place to place. So, let’s continue in the article about discharging patients from hospital.

“(a) Standard: Discharge planning process.” Imagine that there is actually a standard. Well, most ICU standard is we tell the families, “Well, tomorrow at five o’clock, your loved one is going to LTAC.” Well, that’s not the standard. That is bullying. Nothing else.

So, let’s see what the law says, “The hospital’s discharge planning process must identify, at an early stage of hospitalization, those patients who are likely to suffer adverse health consequences upon discharge in the absence of adequate discharge planning and must provide a discharge planning evaluation for those patients so identified as well as for other patients upon the request of the patient, patient’s representative, or patient’s physician.”

I mean if patient is going from ICU to LTAC and then bounces back to another ICU within 24, 48, or 72 hours, that is an adverse health consequence because no discharge plan has been made. It’s simply driven by ICUs needing beds and by ICUs wanting to cut cost. Let’s continue.

“(1) Any discharge planning evaluation must be made on a timely basis to ensure that appropriate arrangements for post-hospital care will be made before discharge and to avoid unnecessary delays in discharge.

(2) A discharge planning evaluation must include an evaluation of a patient’s likely need for appropriate post-hospital services, including, but not limited to hospice care services, post-hospital extended care services, home health services, and non-health care services and community-based care providers, and must also include a determination of the availability of the appropriate services as well as of the patient’s access to those services.”

You can’t tell me that if a patient doesn’t have access to the ICU bed where they got discharged from, that access to the services, is guaranteed. It’s clearly not. Let’s carry on in the article.

“(3) The discharge planning evaluation must be included in the patient’s medical record for use in establishing an appropriate discharge plan and the results of the evaluation must be discussed with the patient (or the patient’s representative).

(4) Upon the request of a patient’s physician, the hospital must arrange for the development and initial implementation of a discharge plan for the patient.

(5) Any discharge planning evaluation or discharge plan required under this paragraph must be developed by, or under the supervision of, registered nurse, social worker, or other appropriately qualified personnel.

(6) The hospital’s discharge planning process must require regular re-evaluation of the patient’s condition to identify changes that require modification of the discharge plan. The discharge plan must be updated, as needed, to reflect these changes.

(7) The hospital must assess its discharge planning process on a regular basis. The assessment must include ongoing, periodic review of a representative sample of discharge plans, including those patients who were readmitted within 30 days of a previous admission, to ensure that the plans are responsive to patient post-discharge needs.”

Again, if a patient is bouncing back into ICU within less than 24 to 72 hours but even if they bounced back within less than a week, those plans have not been thought through carefully enough.

“(8) The hospital must assist patients, their families, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to, HHA (home health agency), SNF (skilled nursing facility), IRF (inpatient rehabilitation facility), or LTAC data on quality measures and data on resource use measures. The hospital must ensure that the post-acute care data on quality measures and data on resource use measures is relevant and applicable to the patient’s goals of care and treatment preferences.

(b) Standard: Discharge of the patient and provision and transmission of the patient’s necessary medical information. The hospital must discharge the patient, and also transfer or refer the patient where applicable, along with all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences…” Treatment preferences, imagine that. “…at the time of discharge, to the appropriate post-acute care service providers and suppliers, facilities, agencies, and other outpatient service providers and practitioners responsible for the patient’s follow-up or ancillary care.

(c) Standard: Requirements related to post-acute care services. For those patients discharged home and referred for HHA services, or for those patients transferred to a SNF, which stands for skilled nursing facility, post-hospital extended care services, or transferred to an IRF or LTAC for specialized hospital services, the following requirements apply, in addition to those set out at paragraphs (a) and (b) of this section:

(1) The hospital must include in the discharge plan a list of HHAs, SNFs, IRFs, or LTACs that are available to the patient, that are participating in the Medicare program, and that serve the geographic area (as defined by the HHA) in which the patient resides, or in the case of a SNF, IRF, or LTAC, in the geographic area requested by the patient. HHAs must request to be listed by the hospital as available.”

Now again, I have seen when it comes to the geography or location of an LTAC or an SNF, a skilled nursing facility. We have worked with clients where the hospital is asking a patient to go to another state. Can you imagine? Can you imagine them? I’ve seen, especially in Florida, I’ve seen many hospitals ask the patient to go to Georgia to an LTAC. That is absolute madness and it’s not in the patient’s best interest. What about the family that needs to be with their family member? They can’t just be traveling to another state.

Now, let’s continue on here. “(i) This list must only be presented to patients for whom home health care post-hospital extended care services, SNF, IRF, or LTAC services are indicated and appropriate as determined by the discharge planning evaluation.

(ii) For patients enrolled in managed care organizations, the hospital must make the patient aware of the need to verify with their managed care organization which practitioners, providers or certified suppliers are in the managed care organization’s network. If the hospital has information on which practitioners, providers or certified supplies are in the network of the patient’s managed care organization, it must share this with the patient or the patient’s representative.

(iii) The hospital must document in the patient’s medical record that the list was presented to the patient or to the patient’s representative.

(2) The hospital, as part of the discharge planning process, must inform the patient or the patient’s representative of their freedom to choose among participating Medicare providers and suppliers of post-discharge services and must, when possible, respect the patient’s or the patient’s representative’s goals of care and treatment preferences, as well as other preferences they express.”

Well, most preferences our clients express is not to go to LTAC in the first place for all the reasons that I mentioned.

“The hospital must not specify or otherwise limit the qualified providers or suppliers that are available to the patient.”

Lastly, (3) The discharge plan must identify any HHA or SNF to which the patient is referred in which the hospital has a disclosable financial interest, as specified by the Secretary, and any HHA or SNF that has a disclosable financial interest in a hospital under Medicare. Financial interests that are disclosable under Medicare are determined in accordance with the provisions of part 420, subpart C, of this chapter.”

Now again, I will link to the law below this video. Just for the last section here, there are plenty of hospitals that refer to their own LTACs. Therefore, there is a financial conflict of interest. Anyway, I hope that confirms everything that I’ve been saying for many years. I will again link towards this article below this video.

Now, if you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

Also, if you have a loved one in a situation like I described where the ICU is wanting to push you to LTAC, also have a look at Intensive Care at Home as an alternative solution. Go to intensivecareathome.com. This is mainly for our viewers in Australia. We operate with Intensive Care at Home all around Australia but also now in the U.S. Please contact us if you’re in the U.S., or in the U.K., or in Australia.

Also, have a look at our membership for families in intensive care at intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, in a membership area and via email and we answer all questions, intensive care related, and Intensive Care at Home related.

Now, if you need a medical record review, please contact us as well. We review medical records in real time so that you can get a second opinion in real time. I also consult with you directly, with doctors and nurses directly so please contact us. We also provide medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you’re simply suspecting medical negligence.

Now, thank you so much for watching.

Please subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next and what questions and insights you have from this video.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.