Quick Tip for Families in Intensive Care: Must LTAC’s (Long-Term Acute Care) in the U.S. Provide ICU Level Care for a Ventilated & Tracheostomy Patient Transferred from ICU?

“Does a LTAC (Long-Term Acute Care) in the United States of America have a duty to provide ICU level care, i.e., follow sepsis protocols, wound care monitoring, inotropes, vasopressors, dialysis for a ventilated and tracheostomy patient transferred from ICU to the LTAC?” That’s the question I’m going to answer today for one of our clients.

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

It’s a great question and it comes as part of a medical record review that we’ve done for this particular client. So, the answer is yes, that LTACs or known as long-term acute care hospitals in the United States do have a duty to provide ICU level care when needed, especially for patients on ventilators or recovering from critical illnesses like sepsis or severe wounds. However, the problem here is that LTACs are not staffed like ICUs and here is why.

For example, when it comes to sepsis protocols, LTACs are required to follow hospital-level standards, including sepsis recognition and treatment bundles, like early antibiotics, fluids, and monitoring. However, they often don’t have the skill level, the knowledge, the staffing levels, etc.

Wound care. LTACs usually have specialized wound care teams. They often do more aggressive wound management than actually regular hospitals because many patients have complex pressure ulcers or surgical wounds, which is also patients from ICU are often being discharged too early to LTACs and they’re bouncing back into ICU.

Monitoring. LTACs can provide continuous vital sign monitoring for ventilated patients with tracheostomy, heart rate, blood pressure, oxygen levels, but nurse to patient ratios are usually much lower than in the ICU, meaning that one nurse might care for more patients at a time than in an ICU. ICU is usually 1:1, whereas in LTAC, it can be 1:4, I’ve heard 1:5, sometimes 1:10 overnight. That’s crazy.

Next, ventilator management. LTACs are not experienced in managing tracheostomy and ventilated patients. They typically don’t have respiratory therapists or ICU doctors on staff 24/7. When you look at LTACs’ website, you will see the best marketing ever. You will read that, they are the experts and specialists that weaning patients off the ventilation and tracheostomy. Have a look at actually Google reviews or any reviews you can find online from actual patients or families, you will find the contrary.

Next, escalation of care. If a patient at an LTAC deteriorates, i.e., worsens sepsis, unstable vital signs, they must stabilize and transfer the patient back to an ICU if they can’t safely manage it, and most of the time they can’t safely manage it. So in short, most of them can’t provide the higher level of care that is needed for ventilated and tracheostomy patients when it comes to sepsis, wound care, dialysis, inotropes, and vasopressors.

Like I said, you will find that LTACs are not really equipped to take patients from ICU to LTAC . I’ve made a video a while ago in one of my YouTube live videos where a video with the title, “10 Reasons Why LTACs in the U.S. are a Scam”, and I stand by it. Because have a look at the online reviews, we have done medical record reviews. We’ve worked with clients in LTAC that have literally been begging us to help them get their loved ones out of LTAC. That’s how bad it was.

In the ideal world, they must recognize when a patient’s condition exceeds their capabilities, but they don’t really, because we often also see that patients that have gone from ICU to LTAC bounce back into ICU within less than 24 or 48 hours because patients are being discharged way too early.

So, LTACs are not ideal for slow respiratory weaning that needs to happen in ICU and are not ideal for actively deteriorating patient. If a patient is still extremely unstable, which most patients on ventilation with tracheostomy are, and if they get new onset severe sepsis, they need to stay in ICU or need to get transferred back to an ICU as quickly as possible.

So, I hope that helps everyone understand why patients should stay in ICU and not go to LTAC. ICUs are well equipped to wean patients off ventilation with tracheostomies, whereas LTACs simply are not.

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’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care, including avoiding transfers from ICU to LTAC.

You can verify that if you go to our intensivecarehotline.com testimonial section at intensivecarehotline.com or if you go to intensivecarehotline.com podcast section  where we have done client interviews. When you read the testimonials or you watch the podcast with our clients, you will recognize that our advice is absolutely life changing. It’s absolutely life changing. Like I said, we’ve helped many clients to save their loved one’s lives. We have many clients in the U.S. to let their loved ones stay where they belong, which is often ICU and not go to an LTAC prematurely.

You can join a growing number of members and clients that we have helped over the years to improve their lives instantly, making sure they make informed decisions, have peace of mind, control, power, and influence, making sure their loved ones get best care and treatment always.

That’s why I do one on one consulting and advocacy over the phone, Zoom, Skype, 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. I make sure you ask the right questions. I make sure you understand everything that’s happening with your critically ill loved one so that you can ask the right questions and get the right outcomes. I also talk to doctors and nurses directly on your behalf or with you or I set you up with the right questions. I’ll make sure 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 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.

Take care for now.

Related Articles:

Quick Tip for Families in Intensive Care: What is Considered Life Support? Quick Tip for Families in ICU: Why Quality of End of Life in ICU Matters! Quick Tip for Families in Intensive Care: How to Deal with Setbacks in Intensive Care! Quick Tip for Families in ICU: Should BIPAP Only be Used in ICU or Can it Be Used on a Hospital Ward? Quick Tip for Families in ICU: 32-year-old Son’s in ICU with Pneumonia, Sepsis, Multiple Organ Failure for 7 days & ICU Team Says He’s Going to Die! Help!