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Quick Tip for Families in Intensive Care: ICU Wants My 71 Year Old Mom with Spinal Injury, Ventilator & Tracheostomy in LTAC (Long-Term Acute Care). How to Stop a Transfer?

“The ICU team is mentioning putting my 71 year old mother with a tracheostomy and a ventilator with a spinal cord injury in an acute care rehab. What should I do?” That’s an email that I have here from Sarah, and I’m going to read out the email and answer Sarah’s question.

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

So, Sarah says,

“The ICU team is mentioning putting my 71 year old mother in an acute care rehab from ICU. She has a spinal cord injury and is paralyzed from the chest down. She was intubated and now has a tracheostomy. They are trying to wean her from the ventilator but have only had 4 hours of success to wean her off it. Your articles at intensivecarehotline.com suggest a long-term acute care facility should be avoided at all costs. She’s on Medicare. The ICU says it will provide better rehabilitation for her.

From, Sarah.”

Sarah, thank you so much for reaching out with that question. You are right on the money here. You do need to avoid sending your mom from ICU to long-term acute care rehab or long-term acute care facility because they are disaster areas, and it’s not only that I’m suggesting that on my website at intensivecarehotline.com, it’s also have a look at their online reviews, see what the people say, and how they’re voting, and that would be my recommendation here. See what people are saying online. So, really thanking you for sharing this, Sarah, because you are absolutely right to be overly cautious and thoughtful about your mom’s situation.

Here’s a breakdown of what you’ve been told and what you need to consider very carefully. So, let’s look at some key facts about long-term acute care hospitals, also known as LTACHs. Well, the hospital and the ICU says it’s better rehab for your mom, she needs time to wean off the ventilator, and this is the next step after ICU. These are things that ICUs are saying.

Now, the reality is that many, if not most, LTACs, also called acute care rehab, are probably not offering the same level of monitoring, staff ratios, or respiratory care as ICU. For a ventilator dependent patient with high needs, like your mom, this can be dangerous, risky, and even lethal.

So, according to intensivecarehotline.com and backed by experiences from many families and also backed by many online reviews from LTACs, LTACs are not always equipped for unstable or high acuity patients, or for patients on ventilation with tracheostomies, because they need close monitoring, and ideally, daily input from respiratory therapists, ICU trained nurses, intensivists, which LTACs most of the time, lack.

Rehab, as a matter of fact, in LTAC is often minimal unless the patient is stable enough and many patients leaving ICU are simply not stable enough, or I should say many patients that leave ICU going to LTAC are not stable enough. As a matter of fact, I even recorded a video or a YouTube Live that I’ve done a while ago, “10 Reasons Why LTACs in the U.S. are a Scam,” and I will link to this video in the written version of this blog, because I really do a deep dive there why they need to be avoided at all costs.

Now, Medicare considerations. Medicare typically covers LTACs if the patients meets the criteria like 25+ day stays, covers inpatient rehab, or skilled nursing facilities, depending on the level of need, but Medicare coverage doesn’t mean it’s the best care setting. Your mom is very vulnerable right now, if anything, Medicare covers the one size fits all approach. It’s usually 60 days in ICU in the U.S., and then, they try to ship patients out to LTAC.

However, if your loved one still needs ICU after 60 days, and they do, especially if they’re on a ventilator with a tracheostomy, then you should do an appeal. You should challenge it, we can help you with that. We have helped so many families in intensive care, keeping their loved ones in ICU instead of going to LTAC. We have a proven track record for that.

So, what are questions you should be asking before agreeing to a transfer?

First question you need to ask, can’t your mom be weaned off the ventilator in ICU first? She’s only had 4 hours of weaning, which is not enough time to keep up on ICU level care.

Next, what’s the staff to patient ratio at the LTAC? Is there 24/7 respiratory therapy? 24/7 ICU nurses? 1:1 nurse to patient ratio? Are there intensive care specialists? Is there even a doctor in-house 24/7, and if so, what are their qualifications? What are the rehab services really like? How often would you get physical therapy, OT like occupational therapy, speech therapy? Are they even experienced with paralyzed ventilated patients? What is the track record of this specific LTAC? Look at infection rates, ventilator weaning success, and family reviews online.

Also, when you lose access to more aggressive treatment options if your condition worsens there. So, for example, one advantage of staying in ICU is usually have access to all specialists, cardiologists, nephrologists, neurologists, surgeons. You won’t have that in an LTAC.

So, what are alternative options?

The first alternative option is stay in ICU longer because your mom will benefit from more ventilator weaning attempts in a better monitored setting. Transfer to a better hospital, one with a high quality spinal cord injury program and ventilator weaning protocol, ventilator capable skilled nursing facilities in the U.S., sometimes better staffing and some LTACs but also needs vetting.

Lastly, Intensive Care at Home. Have a look at intensivecareathome.com for your mother as a next step as well.

Now, your advocacy matters. You can push back and say, “We are not comfortable with the transfer yet. She’s only had 4 hours of weaning. We want to exhaust ICU level care and explore a safer alternative.” Also, ask for a care conference with the attending doctors, respiratory therapist, ICU nurses, case manager, and potentially a director from the LTAC. Also, ask for the ICU hospital discharge policy because I can almost guarantee you, they’re not allowed to send your mom to an LTAC without your permission, without your consent.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over 5 years in critical care. I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that by looking up our intensivecarehotline.com testimonial section, you can see what our clients say there. You can also look at intensivecarehotline.com podcast section where we have done client interviews.

Our advice is absolutely life changing, that means we will help you to improve your life instantly, by making sure you make informed decisions, have peace of mind, control, power and influence making sure that your loved one gets best care and treatment always. You can join a growing number of members and clients that we have helped over the many years, hundreds and hundreds if not thousands of them.

That’s why I do one on one consulting and advocacy for families in intensive care over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you can’t afford to get wrong. When I talk to you and your families directly and handhold you through this process, I also talk to doctors and nurses directly, with you on your behalf. Once I set you up with the right questions to ask, and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams.

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

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 videos and 21 e-books that only are exclusively accessible to our members. All of that will help you to make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

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] with your questions.

If you like my videos, 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, what questions and insights you have.

I also do a weekly YouTube live where I answer your questions live on a show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel, or if you are a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

Thank you so much for watching.

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

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