Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals, January 12, 2022
Determining the appropriate post-acute care (PAC) delivery setting for a patient based on his or her medical needs is essential to achieving optimal outcomes and reducing readmissions, especially immediately following a stay in the ICU.
However, not all post-acute providers have the same capabilities, and therefore do not care for patients with the same clinical needs.
While long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs), two of the four pillars of the post-acute continuum, are often misunderstood as fulfilling the same role, they exist to care for patients with different admitting conditions and severity of illness.
View the infographic below to gain insight into the typical patient profile at each setting, as well as how to best meet patient needs.
Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals, December 1, 2021
As a result of the pandemic and increased consumerism, patients are more interested than ever in their healthcare.
Therefore health systems must become more attentive to patient satisfaction, an important aspect of value-based care.
Patient-centered tools such as care plan transparency, shared technology, and post-discharge communication are being implemented to meet consumer expectations and improve outcomes.
This article outlines research on patient engagement and improved outcomes, as well as three key strategies providers are implementing to deliver on these outcomes.
How patient engagement improves outcomes
Trending: Consumer interest in health
In recent years, consumers have taken a greater interest in their overall health, especially those with chronic illnesses. In a 2020 survey, 66% of respondents with chronic conditions were more interested in taking a proactive approach to health, and 56% were more interested in managing their underlying conditions than prior to the pandemic.1
Benefits to patients
Providers and payers are seeing the benefits that greater involvement can have on patient satisfaction and outcomes.
Recent studies support this connection with the following conclusions:
Patients with a lower degree of involvement, are more likely to experience “major medication errors, emergency department visits, and/or unplanned readmission”.2
Inpatients who are less satisfied with their care are more likely to readmit within 30 days.3
Benefits to providers
Research also reveals that patient involvement lowers total cost of care:
Patients with the lowest engagement rates showed total costs of care that were 21% higher in the following year than those of patients with high engagement scores.4
Patient satisfaction is linked to greater market share, fewer malpractice claims and higher reimbursement rates.5
These studies reveal the benefits to patients, providers, and payers of increasing engagement and satisfaction.
3 Key Patient Engagement Strategies
Patient inclusion in care discussions
In traditional interdisciplinary care teams, physicians and caregivers coordinate treatment which improves efficiency, transparency, and quality of care.
When providers establish practices for patients to also participate in these conversations, coordinated care becomes even more effective. Patients involved in care decisions have:
More realistic expectations of side effects or recovery time
Less treatment anxiety
Greater adherence to treatment plans
These benefits all contribute to greater patient satisfaction and improved outcomes, thereby reducing total cost of care.6
Informative technologies
Technologies that help patients, families, and caregivers communicate and track progress also enhance patient-centeredness.
Studies show that:
Informed, engaged patients are likely to be more confident regarding their care and rehabilitation and to be satisfied with their overall experience and outcomes.7
Strong patient and family engagement in clinical care contributes to a favorable experience, as well as improved outcomes and reduced costs.8
Technologies that can bridge gaps are critical to patient satisfaction and recovery.
Post-discharge follow-up
Patient-centeredness does not end with discharge, however. Research reveals that:
Patients that were hospitalized with acute conditions are less likely to readmit if they are contacted as part of an early follow-up program.9
In patients with three or more chronic conditions, 20% of readmissions are likely to be prevented if they are contacted by a provider of care within 14 days of discharge.10
There is no significant difference in satisfaction between nurse-led telephone follow-ups and outpatient visits, suggesting that telephonic programs are effective patient engagement tools.11,12
Implementing follow-up services not only improves patient satisfaction but can also reduce rehospitalizations.
How Kindred Hospitals is applying patient engagement strategies
Interdisciplinary Care Teams
Kindred Hospitals’ interdisciplinary care teams of physicians, nurses, and rehabilitation therapists collaborate on treatment plans. As part of their advanced care delivery model, Kindred’s interdisciplinary care teams moved their daily meetings from the conference room to the bedside, thereby increasing transparency and patient and family inclusion.
RehabTracker
With the proprietary app, RehabTracker®, Kindred Hospitals are transforming the way caregivers engage with patients and their families. The HIPAA-compliant app ensures that the patient, clinical team and family both near and far are informed on progress and milestones.
RehabTracker is built with unique functionality to serve medically complex and critically ill patients. It can be used to monitor range of motion exercises and time spent sitting at the edge of the bed. It can also track important aspects of respiratory therapy such as unassisted breathing and oxygen intake and saturation.
AfterCare
The Kindred AfterCare program supports patients post-discharge. Registered nurses contact patients at regular intervals after discharge to discuss durable medical equipment, medications, PCP appointments, and any other needs. This program improves patient outcomes and satisfaction, and reduces readmissions.
Visit kindredmanagedcare.com to request a conversation about how Kindred Hospital’s level of service can help manage your critically complex patients.
Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals, November 1, 2021
As value-based care continues to grow in importance for the nation’s health systems, so will efforts to improve outcomes and lower total cost of care.
While many patients leaving the hospital are able to fully recover at a skilled nursing facility (SNF) or at home, a small percentage of them require continued acute care. Without the proper level of treatment and access to specialized physicians and services, these patients are more likely to readmit to the hospital, thereby increasing total cost.
This whitepaper outlines the distinction in clinical capabilities of long-term acute care hospitals (LTACHs) and SNFs and evaluates the characteristics that make LTACHs the ideal recovery setting for medically complex and critically ill patients leaving an ICU or med-surg unit.
Quick View: Differences between LTACHs and SNFs
Hospital-level staffing allows LTACHs to treat the most medically complex patients
One major differentiator between LTACHs and lower levels of care such as SNFs is staffing. At an LTACH, physicians, many of whom are sub-specialists in areas such as pulmonology, infectious disease, and neurology, provide patients with daily oversight. This contrasts with SNFs where visits from a physician are often much less frequent.
Furthermore, LTACH physicians, along with ICU- and CCU-level clinicians in interdisciplinary care teams, are trained to treat medically complex patients who come to an LTACH with an average of six comorbidities.1 Despite caring for a more complex patient population, LTACHs were still half as likely as SNFs to readmit a patient to an STACH.2
LTACHs also provide 24/7 respiratory therapist coverage which allows them to care for patients with critical pulmonary conditions, mechanical ventilation and tracheostomies.
LTACH expertise in treating medically complex patients has thus played a critical role in reducing costly readmissions for high-risk patients.
Specialized rehabilitation therapists at LTACHs work alongside acute-care clinicians to advance recovery
Unlike in lower levels of care such as SNFs, rehabilitation services at an LTACH are integrated with acute care to help patients with medically complex conditions achieve the fastest and most complete recovery possible. These patients benefit from medical care provided by physicians paired with specialized rehabilitation from physical, respiratory and occupational therapists, as well as speech-language pathologists.
LTACH respiratory therapists are also able to liberate patients from mechanical ventilators, which can have considerable advantages. One study found that protocol-driven ventilator weaning led by respiratory therapists at LTACHs can significantly decrease time on ventilator, mortality and cost of care.3
As such, partnership with LTACHs can help certain patients fully recover more quickly and can lower total cost of care.
LTACH settings are constructed for high-quality care and efficiency
Licensed as acute care hospitals, LTACHs, unlike lower levels of care, are equipped with on-site laboratories, radiology and dialysis which reduce the need for outpatient services. LTACHs are therefore able to increase efficiency and limit potential setbacks that patients may experience as a result of being transported between facilities.
LTACHs also feature negative pressure isolation rooms that allow them to reduce the spread of highly contagious viruses and bacteria. Infection control standards, overseen by a specialized Infection Prevention Nurse, also comply with the requirements of the Centers for Medicare and Medicaid Services (CMS) for general acute care hospital licensing.
These protocols are unmatched by most other post-acute care providers. During the pandemic, lower levels of care such as SNFs that had admitted COVID-19 patients faced challenges in preventing spread of the disease to other residents, while LTACHs largely contained infection within COVID-dedicated units or hospitals.4
Infection prevention is critical both for improving outcomes of patients in the hospital, as well as maintaining the health and safety of staff which is required for efficient hospital operation.
How Partnership with Kindred Can Help
As a pioneer in the long-term acute care hospital industry, Kindred Healthcare has worked with patients and health systems across the country for more than three decades. As a commitment to continued improvement in quality of care, Kindred is achieving disease-specific certifications from The Joint Commission in Sepsis and Respiratory Failure in all its hospitals.
Furthermore, innovations such as the Move Early Mobility Program which aims to incorporate mobilization as early as is safe, have resulted in improved patient outcomes.
Kindred Hospitals are committed to an innovative approach to contracting. Health plan partnerships are customized by product and can be built on DRG rates, negotiated per diem rates, or within value-based agreements.
Visit kindredmanagedcare.com to request a conversation about how Kindred Hospital’s level of services can help manage your critically complex patients.
Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals, August 30, 2021
As value-based care continues to grow in importance for the nation’s health systems, so will efforts to improve outcomes and lower total cost of care.
While many patients leaving the hospital are able to fully recover at a skilled nursing facility (SNF) or at home, a small percentage of them requires continued acute care. Without the proper level of treatment and access to specialized physicians and services, these patients are more likely to readmit to the hospital, thereby increasing total cost.
This whitepaper outlines the distinction in clinical capabilities of long-term acute care hospitals (LTACHs) and SNFs and evaluates the characteristics that make LTACHs the ideal recovery setting for medically complex and critically ill patients leaving an ICU or med-surg unit.
Quick View: Differences between LTACHs and SNFs
Hospital-level staffing allows LTACHs to treat the most medically complex patients
One major differentiator between LTACHs and lower levels of care such as SNFs is staffing. At an LTACH, physicians, many of whom are sub-specialists in areas such as pulmonology, infectious disease, and neurology, provide patients with daily oversight. This contrasts with SNFs where visits from a physician are often much less frequent.
Furthermore, LTACH physicians, along with ICU- and CCU-level clinicians in interdisciplinary care teams, are trained to treat medically complex patients who come to an LTACH with an average of six comorbidities.1 Despite caring for a more complex patient population, LTACHs were still half as likely as SNFs to readmit a patient to an STACH.2
LTACHs also provide 24/7 respiratory therapist coverage which allows them to care for patients with critical pulmonary conditions, mechanical ventilation, and tracheostomies.
LTACH expertise in treating medically complex patients has thus played a critical role in reducing costly readmissions for high-risk patients.
Specialized rehabilitation therapists at LTACHs work alongside acute-care clinicians to advance recovery
Unlike in lower levels of care such as SNFs, rehabilitation services at an LTACH are integrated with acute care to help patients with medically complex conditions achieve the fastest and most complete recovery possible. These patients benefit from medical care provided by physicians paired with specialized rehabilitation from physical, respiratory, and occupational therapists, as well as speech-language pathologists.
LTACH respiratory therapists are also able to liberate patients from mechanical ventilators, which can have considerable advantages. One study found that protocol-driven ventilator weaning led by respiratory therapists at LTACHs can significantly decrease time on ventilator, mortality, and cost of care.3
As such, partnership with LTACHs can help certain patients fully recover more quickly and can lower total cost of care.
LTACH settings are constructed for high-quality care and efficiency
Licensed as acute care hospitals, LTACHs, unlike lower levels of care, are equipped with on-site laboratories, radiology, and dialysis which reduce the need for outpatient services. LTACHs are therefore able to increase efficiency and limit potential setbacks that patients may experience as a result of being transported between facilities.
LTACHs also feature negative pressure isolation rooms that allow them to reduce the spread of highly contagious viruses and bacteria. Infection control standards, overseen by a specialized Infection Prevention Nurse, also comply with the requirements of the Centers for Medicare and Medicaid Services (CMS) for general acute care hospital licensing.
These protocols are unmatched by most other post-acute care providers. During the pandemic, lower levels of care such as SNFs that had admitted COVID-19 patients faced challenges in preventing spread of the disease to other residents, while LTACHs largely contained infection within COVID-dedicated units or hospitals.4
Infection prevention is critical both for improving outcomes of patients in the hospital, as well as maintaining the health and safety of staff which is required for efficient hospital operation.
How Partnership with Kindred Can Help
As a pioneer in the long-term acute care hospital industry, Kindred Healthcare has worked with patients and health systems across the country for more than three decades. As a commitment to continued improvement in quality of care, Kindred is achieving disease-specific certifications from The Joint Commission in Sepsis and Respiratory Failure in all its hospitals.
Furthermore, innovations such as the Move Early Mobility Program which aims to incorporate mobilization as early as is safe, have resulted in improved patient outcomes.
Kindred Hospitals are committed to an innovative approach to contracting. Health plan partnerships are customized by product and can be built on DRG rates, negotiated per diem rates, or within value-based agreements.
Visit kindredmanagedcare.com to request a conversation about how Kindred Hospital’s level of services can help manage your critically complex patients.
Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals, July 30, 2021
In today’s intense healthcare environment, collaboration between acute and post-acute providers as well as payors has been particularly essential.
Recent analysis conducted by ATI Advisory, a Washington, DC-based research and advisory services firm, evaluated post-acute provider performance during the public health emergency using claims data from Centers for Medicare and Medicaid Services (CMS).
This article outlines the key findings of the resulting study Role of LTAC Hospitals in COVID-19 Pandemic that reinforce the positive outcomes of long-term acute care hospital (LTACH) partnership.
The Value of Partnership for a Niche Patient Population
The ATI Advisory study highlights that, during the pandemic, strong communication and partnerships between acute hospitals and LTACHs were critical in managing COVID and non-COVID patients: “[Short-term acute care hospitals (STACHs)] turned to LTACHs to relieve capacity constraints and admit and support, without disruption, patients with more intensive needs.”
The value that LTACHs brought to managed care plans and their patients was also emphasized in the report. Specifically, it noted that “LTACHs that appropriately redesigned processes during the pandemic were able to (a) deliver better COVID-specific care and (b) highlight the LTACH model’s unique capabilities.”
As the benefits of transparency and collaboration are becoming more apparent due to the pandemic, payors should continue to ensure their partners are meeting these expectations.
LTACH Population Is Becoming More Acute, Even with Waivers
While the temporary prior authorization relief has expired in many areas, it is important for managed care organizations to recognize that it encouraged flexible care pathways between STACHs and post-acute care settings. The waivers enabled STACHs to improve patient flow and minimized unnecessary disease exposure (COVID-19 and otherwise) through shorter lengths of stay. The streamlined process also resulted in improved care and outcomes for LTACH-appropriate patients.
According to the report, CMS claims indicate that LTACHs remained a specialty setting for the sickest patients. Despite federal waivers that loosened stringent requirements for LTACH admission, LTACHs cared for an even more complex patient population during the COVID-19 pandemic, as supported by an increased Case Mix Index (CMI) from January to May 2020.
Also within the study, the shorter average length of stay (ALOS) at an LTACH compared to other post-acute care providers was recognized as a differentiator. One VP of Population Health Management at a Managed Care Plan stated, “If a patient is going to a SNF but staying 45 days and would have only stayed 20 in the LTACH and then gets discharged home, that’s probably a better outcome.”
As patients become more medically complex, payors should ensure their networks include the specialized, effective care settings these patients require.
The Benefits of LTACHs Within Payor Partnerships
Going forward, the study indicated that “LTACHs can leverage their meaningful role during COVID-19 in order to foster new conversations with plans and policymakers to share metrics, increase transparency, and collaboratively develop new patient pathways that reduce friction during patient transitions.”
Providers and physicians interviewed by ATI Advisory collectively indicated that the capabilities of LTACHs extend the capacity of short-term hospitals as well as deliver a particularly helpful clinical expertise for a COVID-19 population – that of treating patients on a ventilator or in respiratory failure.
The COVID-19 pandemic has highlighted shortfalls in our nation’s healthcare system, yet it has also provided opportunity for providers to collaborate in new ways and has underlined the value of LTACHs in caring for the most critically ill patients, including those with COVID-19.
How Kindred Can Help Manage Your Medically Complex Patient Population
Acute care providers and payors need partners who can provide the physician-directed care these medically complex patients require.
Kindred Hospitals specialize in the treatment of patients needing intensive care and specialized rehabilitation in an acute hospital setting.
With daily physician oversight, ICU- and CCU-level staffing, 24/7 respiratory coverage and specially-trained caregivers, Kindred Hospitals improve functional outcomes, reduce costly readmissions and help patients transition home or to a lower level of care.
Throughout the pandemic, Kindred Hospitals have proved to be a key partner in decompressing ICUs. Kindred Hospitals also demonstrated integrity by maintaining a commitment to treating only medically complex patients, despite the removal of prior authorization that could have allowed for admission of patients who would benefit from a lower level of care.
Kindred Hospitals offer health plan partnerships that are customized by product and can be built on DRG or negotiated by per diem rates.
Visit kindredmanagedcare.com to request a conversation about how Kindred Hospital’s level of service can help manage your critically complex patients.
Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals, June 30, 2021
The pandemic has pushed infection control standards to the forefront as patients and providers are counting on advanced protocols to reduce viral spread and prevent further outbreaks.
Now more than ever, it’s important for patients to be treated in a care setting that is not only best suited to their medical needs but also upholds the highest federally and clinically-recognized health and safety requirements.
This guide highlights five standards maintained by long-term acute care hospitals (LTACHS) to combat infection and protect the most vulnerable of patients, and the benefits of these hospital-based standards compared to other levels of care.
Levels of Care: Comparing Infection Protocols
As healthcare leaders continue to make bold changes to protect the health and safety of patients during this time, LTACHs have adapted to meet the advanced needs of the critically ill and medically complex – including those recovering from COVID-19. When patients are stabilized in the acute care setting, it’s important for providers to be aware of the infection prevention protocols of various post-acute care settings that optimize long-term patient recovery.
#1. Certifications
Many of the certifications set forth by federal programs and agencies are the foundational pieces that ensure standards of patient care are consistently met, including in the areas of quality and safety. LTACHs are required to adhere to a set of stringent operational guidelines, which ultimately benefits patients who receive care in these settings:
LTAC hospitals are licensed as general acute care hospitals, and must comply with the same health and safety requirements¹.
LTAC hospitals must meet state licensure requirements to ensure they are able to effectively manage the extensive care needs of critically ill, medically complex patients who require a longer recovery period.
#2. Staffing
Appropriate staffing is key to overseeing a medically complex patient population. LTACHs are staffed to provide 24/7 care under the guidelines set forth by CMS, as well as additional guidelines established at the facility level to ensure there are personnel fully dedicated to infection control. Some key benefits of these advanced staffing guidelines include:
Through the CMS Medicare program, LTAC hospitals require daily physician oversight and a 24/7 RN presence.
LTACHs feature hospital-level infection prevention and control overseen by an Infection Control Nurse.
In addition to the physician-led interdisciplinary care, patients at LTACHs have immediate access to credentialed, infectious disease physicians and other medical sub-specialists.
#3. Employee Protection
As the recommendations for personal protective equipment (PPE) continue to ramp up based on the care setting, LTAC hospitals can rely on their long-standing practices of infectious disease control and treatment, infection prevention and promotion of safety at the highest level.
Additionally, LTAC hospitals participate in ongoing education regarding preventing and minimizing the spread of viruses and infections. For example:
Competencies and special employee training are built in to address myriad multi-drug resistant organisms, viruses and infections in order to prevent or minimize their spread.
Many LTAC hospital systems, like Kindred, have a well established and robust PPE supply chain with standard best practices to react to a full range of infections and communicable diseases.
#4. Patient Safety
In addition to well-established PPE best practices and infection control training, LTAC hospitals have additional guidelines in place to protect the patient. LTACHs are engineered with patient safety top of mind. Some standards often unseen in other care settings include:
Protocols to isolate infected patients, dedicated teams that monitor for outbreaks and multiple levels of protective gear.
On-site testing and services that enable LTAC hospitals to meet a full range of patient needs without relying on outpatient services.
LTAC hospital licensing requires hospital-quality air filtration systems.
#5. Advanced Clinical Expertise
LTAC hospital professionals are leading industry experts in ventilator care, with best-in-class capabilities in weaning the most challenging ventilator-dependent patients, all while remaining committed safety. Kindred LTACHs partner with agencies that help further its clinical expertise in infection control through several initiatives:
Kindred has been recognized for its leading antimicrobial stewardship and infection prevention efforts².
Kindred regularly cooperates with state, local and federal agencies, including public health departments, to study and better understand how all healthcare providers can help prevent disease spread.
If you have a post-COVID patient, or other patients in need of care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. If you are unsure of who your Kindred representative is, please feel free to contact us via recoveratkindred.com.
Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals, April 1, 2021
Recent research indicates that acute respiratory failure mortality rates are continuing to increase, further heightened by COVID-19 and the seasonal flu.
For patients experiencing respiratory failure conditions, acute care after the initial hospital stay plays a critical role in patient outcomes and readmissions.
This guide details the growing need for pulmonary care expertise and how long-term acute care hospitals can play a role in treating these medically complex patients
The Increasing Demand for Pulmonary Care: Respiratory Failure and COVID-19 Figures
A recent study published in the journal Chest found that respiratory failure affects Americans in the following ways:1
• Acute respiratory failure mortality rates have increased over the past 5 years.
• Rates of acute respiratory distress syndrome have persisted.
• Mortality from respiratory failure and acute respiratory distress syndrome (ARDS) increase during flu season.
• The combination of the flu and COVID-19 will likely further increase mortality rates.
Additional studies show that COVID-19 patients often experience significant pulmonary complications as a result of the virus and its side effects, including severe pneumonia and ARDS.
One recent study analyzed those who admitted to an LTACH with acute infectious complications of COVID-19 pneumonia requiring long-term respiratory support.2 The study suggested that these patients, admitted for weaning from prolonged ventilation, continue to require considerable medical interventions due to the long-term effects of the combined COVID-19 virus and acute-on-chronic diseases.
The researchers concluded that the increased need for pulmonary care expertise must be supported in other care settings as intensive care units (ICUs) face bed and staffing shortages.
These findings highlight the growing need for pulmonary expertise within both traditional hospitals and post-acute partner settings in order to address intensifying respiratory concerns.
LTAC Hospital Expertise in Pulmonary Care and Recovery
A patient’s long-term recovery is directly dependent on the intensity of the care they receive. Though all post-acute settings provide value to their most appropriate patient types, they are not all created equal.3 LTACHs are uniquely equipped to continue the acute care initiated in the hospital setting, including the care of patients on ventilators.
When interviewed by ATI Advisory as part of their recent research, one Medical Director of a Risk-Based Physician Group stated:
“LTAC hospitals differentiate themselves because they have a laser focus on patients who are ventilator dependent, have respiratory failure, require dialysis, and have complex [post] surgical needs, etc. – all of that requires a multi-disciplinary approach [in which] LTAC hospitals specialize.”4
During the pandemic, LTACHs have proved to be a key partner in decompressing ICUs as traditional ICUs experience maximized capacity.
How Kindred Can Help Your Respiratory Patients
Acute care providers need partners who can provide the physician-directed care that respiratory patients—particularly those on ventilators—require.
Kindred Hospitals specialize in treating medically complex patients who require intensive care and pulmonary rehabilitation in an acute hospital setting. With daily physician oversight, ICU- and CCU-level staffing, and 24/7 respiratory coverage, Kindred works to improve outcomes, reduce costly readmissions and help patients transition home or to a lower level of care.
Clinical Protocol
Kindred has proven success in treating patients with pulmonary disease and respiratory failure, and in ventilator liberation. Our program structure includes:
• Focused interdisciplinary care teams
• Development of an individualized care plan
• Daily assessment, treatment and therapy following established clinical practice guidelines for ventilator liberation, early mobility, and maintenance of skin integrity
The Joint Commission Certification
We are committed to pursuing innovations in care delivery and payment models to provide new solutions to our patients, as well as to our provider and payer partners.
One such initiative is our effort to achieve disease-specific certification from The Joint Commission for Respiratory Failure in all Kindred Hospitals across the country. Because LTACHs are licensed as a general acute care hospital by the state, this is the same accreditation received by traditional hospitals.
Early Mobility
Additionally, our Move Early Mobility Program incorporates movement as early as is safe into the recovery plan for patients, including those on ventilators. The goal of this program is to combat the many side effects of immobility on healing.
Our interdisciplinary team of clinicians can meet the needs of your patients who have been in an ICU, CCU, or who are chronically ill and readmit to the hospital frequently.
For more information on how Kindred services can help your beneficiaries, or to request a consultation, visit kindredmanagedcare.com.
Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals, December 3, 2020
The latest findings are honing in on the clinical conditions associated with COVID-19, along with the specific care pathways needed for patients, once stabilized, to fully recover.
Specialized care after the initial hospital stay is proving to play a critical role.
Hospitalized COVID-19 patients often experience significant pulmonary complications, including severe pneumonia and acute respiratory distress-like syndrome. Further, many physicians are reporting that patients are developing post-intensive care syndrome (PICS) due to an intensive care unit (ICU) stay measured in weeks rather than days. The virus is also resulting in strokes, and causing sepsis, which can lead to multi-system failure and leave a patient with lasting damage to the lungs and other organs.
This brief details COVID-19 patient care management strategies and research on how the clinical expertise of LTAC hospitals is uniquely suited for post-COVID patients.
Care Solutions for Post-COVID Patients: The Role of LTACHs
A growing body of evidence indicates that the specialized services delivered in long-term acute care hospitals play a unique and positive role in treating patients recovering from COVID-19.
A recent study in the Journal of Rehabilitative Management stated that: “Early rehabilitation of the COVID-19 patients can enhance pulmonary, respiratory function, reduce complications, improve function, cognitive impairments and quality of life."1
Hospitalized COVID-19 patients are receiving life-saving care in an ICU for much longer than the average stay of three to four days and are often reliant on a ventilator, both of which puts them at high risk of developing post-intensive care syndrome (PICS) – a condition that can include ICU-acquired weakness, cognitive or brain dysfunction and other mental health disorders. Specialized care interventions and rehabilitation are needed to address the short- and medium-term consequences of post-COVID patients experiencing PICS symptoms and recovering from extended mechanical ventilation.2
Additionally, as published recently in The Boston Globe3:
Many recovering COVID-19 patients need to be weaned off of ventilators and slowly reintroduced to eating on their own. Some also require speech therapy, pulmonary therapy, and dialysis.
…COVID-19 has reminded the world of the importance of facilities that occupy the middle ground of the critical care landscape.
“In a pandemic, you really do need that kind of intensive care,” said Grabowski, who co-authored a paper advocating for the importance of long-term acute care hospitals. "For years, we said, ‘Why do we need long-term care hospitals?’ And all of a sudden with COVID, we’re saying ‘Why don’t we have more long-term care hospitals?’”
Lastly, a recently co-authored a post in Health Affairs highlighted the critical resource that LTAC hospitals can play during the COVID pandemic.4 Specifically, the researchers suggest that the clinical expertise in LTAC hospitals with “critical care nurses, respiratory therapists, and intensivists” aligns with the ongoing needs of COVID patients. The experts conclude that, “During this unprecedented international crisis, [LTAC hospitals] offer additional opportunities to prepare for and manage the surge of COVID-19 patients experiencing respiratory failure.”
Unique Clinical Presentations Require Specialized Care
Due to the complex medical needs of post-COVID patients, long-term acute care (LTAC) hospitals are a key care setting. LTAC hospitals deliver care for the most difficult-to-treat, critically ill and medically complex patients – such as patients with respiratory failure, septicemia, traumatic injuries, wounds or other severe illnesses complicated by multiple chronic conditions, many of which have been symptoms of post-COVID recovery.
These specialty hospitals are unlike other post-acute care settings because they are licensed as a general acute care hospital by the state and certified by the Centers for Medicare & Medicaid Services (CMS) as an LTAC hospital, and accredited by the Joint Commission under acute care standards. Additionally, care is provided in an interdisciplinary fashion, featuring daily physician visits and specialty physicians based on patient needs. Clinicians are specially trained for the critical care setting and are able to support prolonged recovery times.
How Kindred Hospitals Can Help
We specialize in the treatment and rehabilitation of the post-intensive care and complex medical patient requiring continued intensive care, including specialized rehabilitation, in an acute hospital setting.
Our team of skilled and caring clinicians in our long-term acute care hospitals can be the right partner for you for your patients who have been in an ICU or a critical care unit, or who are chronically ill and readmit to the hospital frequently. We have proven success in treating patients with pulmonary disease and respiratory failure, including a long history of liberating patients from mechanical ventilation and artificial airways. We also have decades of experience treating post-intensive care syndrome (PICS).
Under Kindred’s expert interdisciplinary care, patients receive targeted services including:
Daily physician oversight
Physician specialists
ICU-level care and staffing when necessary
24/7 respiratory therapy coverage
IV pain control management and narcotic/opioid weaning
Early mobilization of both ventilated and spontaneously breathing patients
Antimicrobial management to complete sepsis treatment and prevent antibiotic resistance
Interdisciplinary teams to clarify interventions and monitor progress
A patient-centered, goal-directed care plan addressing function, cognition and medical impairments
Family-focused discharge planning, whether directly to home or to less intense levels of post-acute care
Fary Khan, MBBS, MD, FAFRM (RACP), Bhasker Amatya, DMedSci, MD, MPH, “Medical Rehabilitation in Pandemics: Towards a New Perspective,” Journal of Rehabilitative Management, Vol. 52, Issue 4, April 9, 2020
Stam HJ, Stucki G, Bickenbach J. Covid-19 and Post Intensive Care Syndrome: A Call for Action. J Rehabil Med. 2020;52(4):jrm00044. Published 2020 Apr 15. doi:10.2340/16501977-2677
Dasia Moore, "COVID-19 patients are recovering, but with nowhere to go," The Boston Globe, May 19, 2020
“How Can We Ramp Up Hospital Capacity To Handle The Surge Of COVID-19 Patients? Long-Term Acute Care Hospitals Can Play A Critical Role,” Health Affairs blog, April 13, 2020, DOI: 10.1377/hblog20200410.606195
