LTACH (Long-Term Acute Care Hospital)

LTACHs occupy the highest-acuity tier of post-acute care. They are licensed as acute care hospitals but specialize in patients who need weeks of continued hospital-level treatment after a critical illness: prolonged mechanical ventilation and weaning, complex wound care, extended IV antibiotic courses, and multiple organ system complications. Medicare pays LTACHs under a dedicated prospective payment system, and full LTACH-level payment is generally reserved for cases meeting clinical criteria such as a preceding intensive care unit stay of at least three days or prolonged ventilator use; other cases are paid at a lower site-neutral rate. The 25-day average length of stay requirement is what formally distinguishes an LTACH from a general acute hospital.

The typical flow runs ICU, then LTACH, then a step down to a skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), or directly to home with home health. By the time an LTACH patient reaches home, they have often been institutionalized for one to three months, are severely deconditioned, and carry substantial equipment and medication burdens. Under the Patient-Driven Groupings Model (PDGM), a home health admission within 14 days of an LTACH discharge is an institutional admission source. These patients frequently group into high-acuity clinical groupings, carry high functional impairment levels, and qualify for comorbidity adjustments, so they are typically well-reimbursed episodes, matched by genuinely heavy care demands.

Accepting LTACH referrals is a clinical capability decision, not just a growth decision. Expect to need:

• Nurses competent in tracheostomy care, complex wound care including wound vacs, and central line or PICC management
• Home infusion coordination for extended IV antibiotic courses
• Rapid DME and respiratory equipment setup before or at the start of care
• Therapy staff prepared for profound deconditioning and slow functional gains
• Tight physician communication, since these patients often have multiple specialists

Agencies that handle these cases well become the default partner for the LTACH's discharge planners, a durable referral relationship precisely because many competitors decline the acuity.

The main risks are under-scoping and under-documenting. An intake team that treats an LTACH referral like a standard hospital discharge will miss equipment needs and staffing requirements, producing a chaotic first week and a fast rehospitalization. On documentation: capture the institutional stay dates for admission source, code the comorbidity picture completely since it drives the PDGM comorbidity adjustment, and make the OASIS functional assessment reflect the patient's true dependence rather than their trajectory. Also be realistic at acceptance. If the agency cannot staff daily wound care or trach-competent nurses in that territory, a non-admit with a warm referral elsewhere is better than a failed episode, a hospitalization on your claims-based measures, and a damaged LTACH relationship.