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

So, today’s tip is about a question from Amanda who says, “My husband is going to have a tracheostomy on Friday. Why should he not go to a long-term acute care facility?” So, this is obviously a video that’s directly related to our large U.S. based clients that have loved ones in intensive care that need a tracheostomy and then ICUs are trying to ship them out to LTAC as quickly as possible.

So, why should he not go to a long-term care facility? Now, that list is very long, why he should not go to a long-term acute care facility. There’s really nothing where it says you should go to a long-term acute care facility. There are not enough pros to weigh up the cons for going to an LTAC facility, but I’ll break it all down for you in a minute.

But before I break it all down, I do want to say, Amanda, why does your husband need a tracheostomy in the first place? The goal in ICU should always be to avoid a tracheostomy full stop. So, the first question that you need to ask is, have they done everything beyond the shadow of a doubt to avoid a tracheostomy? Have they done everything beyond the shadow of a doubt to get your husband off the ventilator and the breathing tube?

Nine times out of ten, when we work with clients, one-on-one, we’re finding intensive care teams have not done everything beyond the shadow of a doubt to avoid the tracheostomy and wean a critically ill patient off the ventilator and the breathing tube. The simple reason for that, it’s almost like LTACs nowadays are like a safety net. Well, let’s not try too hard because we can always send a patient to LTAC.

Well, the good news is if you have come to intensivecarehotline.com, we educate you that LTACs are big disaster areas. You probably haven’t even thought about that he may not need a tracheostomy in the first place.

The biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for. They don’t know what question to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care, and that is the challenge that you are facing here, Amanda, clearly.

So, why should your husband not go to an LTAC facility? Well, Number 1, look up LTAC reviews online that speaks louder than anything. Look up the reviews online. That’s Number 1.

Number 2, the ICU needs the ICU beds very, very quickly. It’s often quicker for an ICU to do a tracheostomy and send patients out rather than working on avoiding a tracheostomy, extubating your husband and taking out the breathing tube because that can be a little bit of an art rather than a science. It depends on your husband’s condition. You haven’t shared your husband’s condition. Your question is very general here.

There might be a situation because you haven’t shared it, that a tracheostomy is inevitable. Your husband, God forbid he might have a spinal injury, he might have motor neuron disease. He might have some other condition that forces him to have a tracheostomy. So, I don’t know.

That is also why families in intensive care need to do research from Day 1 because otherwise, your questions are very generic. The devil in intensive care is in the detail. I’ve worked in intensive care for over 20 years in three different countries. So, I know all the details that happened at the bedside, tracheostomy, or no tracheostomy.

So, let’s keep focusing why your loved one should not go to LTAC.

The next reason is there are no critical care trained nurses in LTAC. Your husband will be going from 1:1 nurse to patient ratio in intensive care to 1:4 or 1:5 overnight, 1:10 nurse to patient ratio. That’s dangerous. It’s unsafe.

Many, many times when we work with families who have a loved one in LTAC, they’re bouncing back to ICU very, very quickly. Pretty much all of our predictions come true very, very quickly because we have seen many times that patients go to LTAC way too early, not that I advocate for LTAC in any circumstances, and then they bounce back into ICU very quickly.

You know what happens then Amanda, sadly enough, patients then often bounce back into another ICU because the ICU where he was discharged from does no longer want to take any responsibilities for their mistakes because they should have never sent your husband into LTAC in the first place.

Number 2, the beds are gone. Once a patient leaves the ICU, it doesn’t take very long for that bed to be occupied again.

So, picture this. Your husband is in ICU, critically ill, probably as close to death as he would ever be. He’s extremely vulnerable. He’s going to LTAC and then he’s going to another ICU, that means he’s in three places within no time. That is, in my mind, the very definition of insanity. Your husband is as vulnerable as he’s ever been and then he’s at risk of going through to three different places in no time on life support. Picture that. So that in and of itself is enough reason for your husband not to go to LTAC.

Next, there’s usually not a doctor on site, let alone an intensivist, or an ICU consultant, or an ICU specialist. There might be a pulmonologist coming in once a day, if at all and no one is taking ownership of weaning your husband off the ventilator and removing the tracheostomy.

Next, there’s often a time limit in LTAC. So, if your husband doesn’t come off the ventilator within the next 30 days, then the next step is to ship him to a nursing home. Whereas LTACs, in reality, are just a slightly better version of a nursing home, anyway. So, you got to think ahead, and you got to be one step ahead. But thankfully, here we can help you or we are helping you to be one step ahead.

Next, LTACs overpromise and underdeliver. We see it so many times. The ICU will promise you LTACs are the specialists in weaning patients off the ventilator. Again, please look up online reviews, look up our case studies. LTACs are anything but.

So, how to stop your husband going to LTAC? Well, it’s simple. It is really simple for your husband not to go to LTAC and be weaned off the ventilator and ICU, which is where all the resources, all the knowledge, all the skills are there.

So simple steps, (A), hospitals cannot discharge patients without patient or power of attorney consent. Enough has been written about it, enough has been documented about it. It’s crystal clear that hospitals can’t send patients without patient or family consent. That’s illegal. That’s Number 1.

Here is another tip though. You are asking why your husband is going to be having a tracheostomy on Friday. So, here’s another tip, I’m pretty sure they would have asked you by now to do a tracheostomy and the PEG tube as well.

So, my biggest tip from this video is do not give consent to a PEG tube. A PEG tube is a percutaneous endoscopic gastrostomy tube through the abdominal wall and it’s for feeding. It’s to replace a nasogastric feeding tube that goes through the nose, into the stomach, both have the same function.

However, a PEG tube is often a permanent thing and people look at a PEG tube that like it’s permanent and people will never eat or drink again, and that’s terrible. So, you have to think about that. Keeping the nasogastric tube in is perfectly fine. Patients can have nasogastric tube for months and there’s no issue.

But here is the, the winner for you, LTACs will not take your husband without a PEG tube because there’s no skills in LTACs, which is why they can’t look after a nasogastric tube. It takes more skills and knowledge to look after a nasogastric tube than it does to look after a PEG tube. So, I hope that summarizes your concern here, Amanda.

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, 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 and Intensive Care at Home related.

I also offer 1:1 consulting and advocacy for families in intensive care over the phone, via Zoom, via Skype, via WhatsApp, whichever medium works best for you. I can represent you in family meetings with the intensive care team, getting real outcomes. Have a look at our podcast, have a look at our testimonial section where we help countless of families in intensive care, saved lives. There are client interviews and showcase the work that we’ve done. So, it’s all there for you.

We also offer medical record reviews in real time, i.e., giving you a second opinion in real time. Please contact us for that. We also provide medical record reviews after intensive care for unanswered questions. If you need closure or if you are suspecting medical negligence, please contact us as well.

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

Thanks for watching.

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

Take care.