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

So today, I want to actually focus on what are the most important questions that you need to ask when ICU is telling you your loved one should go to an LTAC (Long Term Acute Care). Now, one disclaimer here, this is for our audience in the United States, LTACs don’t exist outside of the United States. So therefore, this is really specifically for our U.S. audience because we’re having inquiries almost every day: “What should I do if ICU is telling you that your loved one needs to go to LTAC?”, and you only really get asked that question if your loved one ends up having a tracheostomy and is ventilated, or sometimes if your loved one does manage to get off the ventilator in ICU, they still might ask you to go to LTAC. So, let’s dive right into it.

The first question that you should be asking is, “Is this a good LTAC?” From my experience, there are no good LTACs. I mean, look up the LTAC reviews online, they are absolutely appalling. We have families literally begging us trying to help them to go back to ICU once they have been discharged to LTAC because they’re doing their research too late. Have a look at the online reviews, what they’re saying, and the online reviews are pretty dismal.

The next question you need to ask is, “What is the qualification level of the nurses there?” Are they critical care trained? Are they having ICU experience? Because once again, when someone is on a ventilator with a tracheostomy, they need ICU nurses 24 hours a day, and most LTACs don’t have it. Let’s call it for what it is.

The next question you need to ask is, “What is the nurse-to-patient ratio?” So, what that means is in ICU, there’s often a 1:1 nurse-to-patient ratio, sometimes 1:2. In LTAC, from my experience, it’s often 1:4, 1:5, sometimes 1:10, which for a ventilated patient that is unsafe. You’re putting a loved one at risk if you let them go to an LTAC.

The next question is, “Is there access to ICU doctors, 24 hours a day, or to specialist doctors?” Once again, my experience after having worked in intensive care for over 25 years in three different countries and after having consulted for families in intensive care all over the world since 2013, is that there are no doctors on site in LTAC or there may be no doctors on site. Certainly, no ICU doctors, let alone any specialist coming and going, they’re not on site all the time. So, medical coverage is pretty average.

That leads me to the next thing, now that you know there is often no specialist doctor cover, and that there is no specialist nursing cover as well, “What are their success rates for ventilation and tracheostomy weaning?” Well, from my experience and they’re not very high because they simply lack the specialist skills there. Often, what we also found is that you’re not even getting an ICU nurse and then sometimes you’re getting LPNs, or nursing aids looking after patients that need ICU care. That further confirms to what I’ve been saying for the longest that LTAC are not designed for clinical need, they are designed for saving money, they’re designed to empty ICU beds, certainly not designed for clinical need.

Next question you need to ask is, “Is physical therapy available?” Now, one thing that we found over the many years working with families in intensive care is that ICUs often “pitch to families in intensive care.” Well, you need to take your loved one to LTAC because there they’ll get physical therapy. Well, my experience is, they’re not. It’s just a sales pitch to get you to sign up for LTAC when you go in there, you will find there is no physical therapy. It’s bait and switch, unfortunately.

Next question you need to ask is, “Is there an ICU on site?” Now, what we’ve seen over and over again, and I have done countless videos about that is that when someone goes from ICU to LTAC, they’re bouncing back to ICU pretty quickly within 24 to 48 hours because patients are getting discharged way too prematurely, and then they bounce back into ICU and they also bounce back into another ICU because the discharging ICU no longer has a bed available. So, then they’re going to another ICU further away. It’s all a mess. So, imagine your loved one goes from ICU to LTAC and then bounces back into another ICU, and been in three places within a short period of time and they are as vulnerable as they can be, that is madness in my mind. It is unsafe and it is not holistic care, it is selfish for the hospital, selfish for the LTACs, it’s not patient centric care.

Next question you need to ask, “How much time does your loved one have in LTAC to get off the ventilator?” So, what we’ve seen once again over and over again and hospitals don’t tell you about it because they’re sneaky is, there’s often only a 30-day window in LTAC to get off the ventilator and the tracheostomy before they suggest for your loved one to go to a SNF (Skilled Nursing Facility), which is even worse than LTAC. Once your loved one has entered SNF, very unlikely they will ever get off the ventilator from my experience.

Now, let’s look at the LTAC experience. Your loved one’s going to LTAC, like I said, they won’t have physical therapy, and they don’t have proper weaning regimes because no one knows what they’re doing. Then the clock is ticking, you have 30 days, it’ll take them two weeks to just get to know your loved one, then your loved one only has two weeks to get off the ventilator, which is not often that long enough. Then after two weeks, they’re already looking for a SNF, Skilled Nursing Facility. Can you see that the 30-day time window is not enough? It is not enough. It’s cutthroat and it is not in your loved one’s best interest. It’s not in your loved one’s best interest to go to an LTAC to begin with. The skills to wean a patient off the ventilator and the tracheostomy are in ICU.

Lastly, ask them for success stories of successful ventilation and tracheostomy weaning, ask them for it. Ask to talk to those families that have been in those situations, whether they managed to get their loved ones off the ventilator or not. Lastly, it’s almost like a bonus, ask them if there is access to specialist doctors such as hematology, dieticians, speech therapy, cardiology, and neurology, whichever specialty you need. Because again, that is often also not available, which then makes it much more likely for your loved one to bounce back into hospital because they’re so unwell, that means specialist input is often needed. So, I hope that explains to you what questions you need to ask.

Then, before I forget about the other thing that you should be asking, “Is it legal to discharge your loved one from ICU to LTAC?” Most of the time it’s not even legal, what I mean by that is they can’t discharge your loved one without you, assuming you have the power of attorney or your loved one’s consent. Let that sink in.

I can verify that by you asking for the hospital discharge policy. I can vouch that if they’re not sharing the hospital discharge policy with you, that’s because the hospital discharge policy will say they’re not allowed to discharge your loved one without you or your loved one’s consent. It’s very simple to put a stop to it. You just need to take guidance and you need to take responsibility. If you’re not taking responsibility, nothing is going to happen. If you blame other people, it’s not going to happen, you need to take full responsibility for everything that’s happening.

That’s also why we created a membership for families of critically ill patients in intensive care that you can get access to by going to intensivecarehotline.com, by clicking on the membership link, or by going to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, and we answer all questions intensive care related and we teach you proven strategies, making sure your loved one gets best care and treatment.

I have worked in critical care for nearly 25 years in three different countries where I also worked as a nurse unit manager for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013, all over the world. I can say without any hint of exaggeration that we have saved lives as part of our consulting and advocacy. Have a look at our testimonial section and have a look at our podcast section where we’ve done client interviews.

Like I said, with all my experience in intensive care, that’s why I also offer one-on-one consulting and advocacy for families in intensive care over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I make sure you make informed decisions, you have peace of mind, control, power, and influence.

99% of families in intensive care don’t have it because they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care. That’s their biggest challenge and with all of my insights, I can turn things around with you very, very quickly.

I obviously offer the one-on-one phone consulting, Skype, Zoom, WhatsApp. I talk to you and your families directly. I talk to doctors and nurses directly and I ask all the questions to the doctors and nurses, in particular that you haven’t even considered asking because of my experience and my ability to communicate with them on a clinical level.

I also represent you in family meetings with intensive care teams. I strategize with you but that’s even the right strategy to go into a family meeting with intensive care teams. But if it is the right strategy, then I will represent you there making sure once again your loved one gets the best care and treatment when you have a loved one in intensive care.

We also offer medical record reviews in real-time so that you can get a second opinion in real-time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

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

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.