Long Term Acute Care Meaning: LTAC Guide in the US

Long-term acute care hospitals (LTACs), specialized healthcare facilities, offer comprehensive treatment for patients with serious medical conditions. The Centers for Medicare & Medicaid Services (CMS) establish specific criteria for these facilities, differentiating them from traditional hospitals. A crucial element of understanding long term acute care meaning involves recognizing the extended recovery periods often required by patients in LTAC settings. Moreover, the interdisciplinary care teams, including physicians and therapists, that are typical in Kindred Healthcare LTAC hospitals emphasize the holistic approach integral to patient rehabilitation within this specialized environment.

Understanding Long-Term Acute Care (LTAC) Facilities

Long-Term Acute Care (LTAC) facilities represent a unique and vital component of the modern healthcare ecosystem.

These specialized hospitals are designed to provide extended medical and rehabilitative care for patients with complex medical needs.

They stand apart from traditional acute care hospitals by focusing on individuals who require a longer length of stay and a higher level of specialized care.

The Niche of LTACs in Healthcare

LTACs fill a critical gap in the healthcare system.

They cater to patients who are too ill or medically complex to be effectively managed in a traditional rehabilitation setting or skilled nursing facility, yet no longer require the intensive, immediate interventions provided in an acute care hospital's Intensive Care Unit (ICU).

This distinction is fundamental to understanding the LTAC's role.

These facilities offer a bridge, providing ongoing medical support and rehabilitation services necessary for patients to regain their health and independence.

Purpose and Scope of This Overview

This article seeks to provide a comprehensive overview of LTAC facilities.

It aims to elucidate their role within the broader healthcare landscape and to offer critical insights for a diverse audience.

This includes patients and their families, healthcare providers, and policymakers.

For patients and families, understanding the function and capabilities of LTACs is crucial for making informed decisions about care options.

LTAC Considerations

For healthcare providers, a clear understanding of LTACs allows for appropriate referrals and collaborative care planning.

Policymakers, in turn, benefit from a nuanced understanding of LTACs to inform healthcare policy and resource allocation.

Ultimately, this overview serves as a resource to promote greater awareness and understanding of the vital role that LTAC facilities play in delivering quality healthcare to patients with complex medical needs.

This is essential for optimizing patient outcomes and ensuring responsible healthcare delivery.

Context and Background: Positioning LTACs in the Healthcare Spectrum

To fully grasp the role of Long-Term Acute Care (LTAC) facilities, it is essential to first situate them within the wider context of the healthcare system.

Understanding their place in the spectrum of care, their distinctions from traditional hospitals, and their historical evolution provides a crucial foundation for appreciating their unique function and value.

The Landscape of Post-Acute Care (PAC)

Post-Acute Care (PAC) encompasses a range of services designed to support patients transitioning from acute hospital settings to lower levels of care.

These services aim to help patients regain function, manage chronic conditions, and prevent hospital readmissions.

LTACs are a critical component of PAC. Other PAC settings include:

• Skilled Nursing Facilities (SNFs)
• Inpatient Rehabilitation Facilities (IRFs)
• Home Health Agencies (HHAs)

LTACs provide a level of care that bridges the gap between intensive acute care and less intensive PAC settings.

They cater to patients who require prolonged medical management and rehabilitation that cannot be adequately provided in other PAC environments.

LTACs vs. Traditional Acute Care Hospitals: Key Distinctions

While both LTACs and traditional acute care hospitals provide inpatient medical care, they differ significantly in several key aspects:

Patient Acuity

LTACs serve patients with higher levels of medical complexity and acuity.

These patients often have multiple comorbidities, require specialized treatments like mechanical ventilation, and need intensive monitoring.

Acute care hospitals, in contrast, typically treat a broader range of conditions, including acute illnesses and injuries requiring shorter-term interventions.

Length of Stay (LOS)

Length of Stay (LOS) is a defining characteristic that distinguishes LTACs from acute care hospitals.

LTACs are designed for patients who require extended hospital stays, typically exceeding 25 days.

Acute care hospitals focus on shorter stays, aiming to stabilize patients and discharge them to lower levels of care as quickly as possible.

Resource Intensity

LTACs are equipped to provide resource-intensive care for prolonged periods.

This includes specialized equipment, dedicated staffing ratios, and comprehensive rehabilitation services tailored to the needs of chronically critically ill patients.

A Brief History: The Emergence of LTACs

The development of LTACs can be traced back to the increasing need for specialized care for patients with chronic and complex medical conditions.

In the 1980s, as medical advancements led to improved survival rates for critically ill patients, a gap emerged in the healthcare system.

Patients who were too sick to be discharged home or to traditional nursing homes required a more intensive level of medical management than could be provided in those settings.

This led to the establishment of the first LTACs, which focused on providing specialized care for ventilator-dependent patients and those with complex wounds and infections.

Over time, the number of LTACs grew, and their scope of services expanded to include a wider range of medical conditions.

Today, LTACs play a crucial role in the healthcare continuum, providing a vital service for patients who require prolonged, intensive medical care and rehabilitation.

Target Patient Populations: Who Benefits from LTAC Care?

To understand the value proposition of Long-Term Acute Care (LTAC) facilities, it is crucial to identify the specific patient populations who stand to benefit most from their specialized services. LTACs are designed to meet the complex medical needs of individuals who require extended care and aggressive interventions not typically available in traditional acute care settings or skilled nursing facilities. This section delves into the key patient groups that find LTAC care essential, along with an examination of the impact of comorbidities on their treatment and recovery trajectories.

Identifying Key Patient Groups

LTACs serve a unique niche by focusing on patients with significant medical complexities. These facilities are equipped to handle a range of conditions that necessitate intensive, long-term management.

Patients with Chronic Critical Illness: This cohort includes individuals who have experienced prolonged stays in the Intensive Care Unit (ICU) due to severe illnesses or injuries.

They often require ongoing respiratory support, hemodynamic stabilization, and management of multiple organ system failures.

The LTAC setting provides the time and resources necessary for these patients to receive comprehensive medical care and rehabilitation aimed at improving their overall health status.

Ventilator-Dependent Patients: A significant portion of LTAC patients are dependent on mechanical ventilation due to respiratory failure or other underlying conditions.

LTACs offer specialized ventilator weaning programs designed to gradually reduce and eventually eliminate the need for mechanical ventilation.

These programs involve a multidisciplinary approach, including respiratory therapists, physicians, and nurses, working collaboratively to optimize respiratory function and promote independence from the ventilator.

Patients Requiring Complex Wound Care: Individuals with chronic or non-healing wounds, such as pressure ulcers, surgical wounds, or diabetic ulcers, often require specialized care to prevent infection, promote healing, and improve overall quality of life.

LTACs provide comprehensive wound care services, including advanced wound dressings, negative pressure wound therapy, and surgical debridement.

These interventions are delivered by skilled wound care specialists who work to manage complex wounds and prevent further complications.

The Significance of Comorbidities

The presence of comorbidities, or multiple co-existing medical conditions, significantly impacts patient care and outcomes in the LTAC setting. Patients with comorbidities often present with more complex medical needs, requiring a coordinated and multidisciplinary approach to treatment.

The interplay of multiple conditions can complicate diagnosis, treatment planning, and recovery.

For example, a patient with chronic obstructive pulmonary disease (COPD), heart failure, and diabetes may require careful management of each condition to prevent exacerbations and improve overall health outcomes.

Furthermore, comorbidities can increase the risk of complications, such as infections, adverse drug events, and prolonged hospital stays.

LTACs are equipped to address these complexities by providing individualized care plans that take into account the unique needs of each patient.

The interdisciplinary team collaborates to manage comorbidities effectively, prevent complications, and optimize patient outcomes.

Effective management of comorbidities in the LTAC setting not only improves the patient's immediate health status but also contributes to long-term health and well-being. By addressing multiple conditions simultaneously, LTACs play a critical role in improving the quality of life for patients with complex medical needs.

Services and Treatment Modalities: A Multidisciplinary Approach

To truly appreciate the unique role of Long-Term Acute Care (LTAC) facilities, it is essential to delve into the comprehensive services and treatment modalities they offer. These facilities distinguish themselves through a strong commitment to intensive medical management, combined with a rehabilitation-focused approach designed to restore patients' functional abilities and overall quality of life. The hallmark of LTAC care is the collaborative effort of an interdisciplinary team, working synergistically to address the multifaceted needs of each patient.

Core Services in LTAC Facilities

At the heart of LTAC care lie two fundamental pillars: intensive medical management and complex medical rehabilitation. These services are not merely add-ons but rather integral components of a holistic treatment plan tailored to the unique challenges faced by patients with chronic and complex conditions.

Intensive Medical Management

LTACs provide round-the-clock physician and nursing care, ensuring that patients receive continuous monitoring and prompt intervention for any medical complications. This level of vigilance is particularly crucial for individuals with unstable medical conditions or those requiring intricate medical procedures. The emphasis on 24/7 availability distinguishes LTACs from other post-acute care settings, where medical oversight may be less frequent or readily accessible.

Complex Medical Rehabilitation

Rehabilitation plays a pivotal role in the LTAC setting, aimed at maximizing patients' functional independence and facilitating their transition back to their homes or other care environments. This involves the integration of physical therapy, occupational therapy, and speech therapy, each contributing to specific aspects of recovery.

• Physical Therapy focuses on improving mobility, strength, and balance, enabling patients to regain the ability to walk, transfer, and perform other essential physical tasks.
• Occupational Therapy assists patients in developing or regaining the skills necessary for activities of daily living, such as dressing, bathing, and eating.
• Speech Therapy addresses communication and swallowing difficulties, ensuring that patients can effectively express themselves and safely consume food and liquids.

The Interdisciplinary Approach: A Symphony of Expertise

The success of LTAC care hinges on the seamless collaboration of a diverse team of healthcare professionals. Each member brings unique expertise and perspectives to the table, working together to create a comprehensive and individualized treatment plan. This collaborative environment fosters a holistic approach that addresses not only the medical needs of patients but also their physical, emotional, and psychosocial well-being.

• Physicians (Pulmonologists, Intensivists, Internal Medicine): Lead the medical team, providing expert diagnosis, treatment, and ongoing management of patients' complex medical conditions.
• Registered Nurses (RNs): Provide direct patient care, administer medications, monitor vital signs, and ensure patient comfort and safety around the clock.
• Respiratory Therapists (RTs): Manage patients' respiratory needs, including ventilator support, airway management, and respiratory treatments.
• Physical Therapists (PTs): Develop and implement exercise programs to improve patients' strength, mobility, and balance.
• Occupational Therapists (OTs): Help patients regain the skills needed for daily living, such as dressing, bathing, and eating.
• Speech-Language Pathologists (SLPs): Evaluate and treat communication and swallowing disorders.
• Case Managers: Coordinate patient care, facilitate communication among the healthcare team, and assist with discharge planning.
• Dietitians: Assess patients' nutritional needs and develop individualized meal plans to promote healing and overall health.
• Pharmacists: Ensure the safe and effective use of medications, monitor for drug interactions, and provide medication education to patients and caregivers.

The interdisciplinary approach is not simply a matter of assembling a team of experts; it requires a commitment to open communication, mutual respect, and shared decision-making. Regular team meetings, clear documentation, and a patient-centered focus are essential for ensuring that each member is aligned and working towards common goals. This collaborative model is what truly sets LTACs apart and allows them to provide the specialized, comprehensive care that their patients require.

Operational Aspects: Admission, Discharge, and Key Performance Metrics

To truly appreciate the unique role of Long-Term Acute Care (LTAC) facilities, it is essential to delve into the comprehensive services and treatment modalities they offer. These facilities distinguish themselves through a strong commitment to intensive medical management, combined with integrated rehabilitation services. However, effective operations are equally crucial for LTACs to fulfill their mission, particularly in the context of admissions, discharges, and the monitoring of key performance indicators.

Admission and Discharge Processes: Orchestrating Patient Transitions

The journey of a patient through an LTAC involves careful coordination, starting with the admission process and culminating in a well-planned discharge. Both phases are critical to ensuring continuity of care and optimal patient outcomes.

Referral Pathways: The ICU as a Primary Source

A significant number of LTAC patients are referred directly from the Intensive Care Unit (ICU). These patients often require prolonged mechanical ventilation, complex wound care, or management of chronic critical illnesses.

Efficient communication and collaboration between the ICU and the LTAC are essential for a seamless transition. This includes the exchange of detailed patient medical records, treatment plans, and specific care needs.

Other referral sources include acute care hospitals, skilled nursing facilities (SNFs), and occasionally, direct referrals from physician practices. Regardless of the source, a thorough patient assessment is required to determine the appropriateness of LTAC care.

This assessment typically involves a review of the patient's medical history, current condition, and potential for improvement with LTAC-level interventions.

Discharge Planning: A Multidisciplinary Approach

Discharge planning in an LTAC is a comprehensive process that begins upon admission. It involves a multidisciplinary team, including physicians, nurses, therapists, case managers, and the patient's family.

The goal is to ensure a safe and effective transition to the most appropriate post-LTAC setting. This may include a return home with home health services, transfer to a skilled nursing facility (SNF), or admission to an inpatient rehabilitation facility.

Effective discharge planning involves several key steps.

First, a thorough assessment of the patient's functional status, medical needs, and psychosocial support systems is conducted.

Second, realistic goals are established, and a plan of care is developed to address the patient's ongoing needs.

Third, coordination with community resources, such as home health agencies or durable medical equipment suppliers, is undertaken.

Finally, patient and family education is provided to ensure they are well-prepared to manage the patient's care at home or in the new setting.

Key Performance Metrics: Monitoring Quality and Efficiency

LTACs, like all healthcare providers, are increasingly scrutinized for their performance. Key performance metrics provide valuable insights into the quality of care, operational efficiency, and patient outcomes.

These metrics are closely monitored by regulators, payers, and hospital administrators to identify areas for improvement and ensure accountability.

Length of Stay (LOS): Balancing Cost and Outcomes

Length of Stay (LOS) is a critical performance metric in LTACs. It reflects the duration of a patient's stay and has significant implications for both cost and patient outcomes.

Several factors can influence LOS, including the severity of the patient's illness, the presence of comorbidities, and the effectiveness of treatment interventions.

Shorter LOS may be desirable from a cost perspective, but it is crucial to ensure that patients receive adequate care and are safely discharged. Premature discharge can lead to readmissions and adverse outcomes.

Conversely, excessively long LOS may indicate inefficiencies in care delivery or a failure to achieve established goals.

LTACs must carefully balance the need to manage costs with the imperative to provide high-quality, patient-centered care.

Mortality Rates: A Sensitive Indicator

Mortality rates are another important performance metric for LTACs. These rates reflect the proportion of patients who die during their stay. They are influenced by patient acuity, the complexity of medical conditions, and the effectiveness of medical management.

While mortality rates are a sensitive indicator, they should be interpreted cautiously, considering the patient population served by LTACs. Many patients admitted to LTACs have severe, life-threatening illnesses, which naturally increases the risk of mortality.

Strategies to improve mortality rates include early identification of high-risk patients, aggressive management of infections and complications, and implementation of evidence-based protocols. Palliative care and end-of-life care services are also crucial for patients with advanced illnesses.

Readmission Rates: A Measure of Transition Success

Readmission rates measure the frequency with which patients are readmitted to the hospital shortly after discharge from the LTAC. High readmission rates can indicate problems with discharge planning, inadequate follow-up care, or a failure to address the underlying medical conditions.

Preventing readmissions requires a multifaceted approach.

First, thorough discharge planning is essential, including coordination with community resources and education for patients and families.

Second, timely follow-up appointments with physicians and specialists are crucial to monitor the patient's condition and address any emerging problems.

Third, strategies to improve medication adherence and prevent infections are important.

Finally, access to home health services and other support programs can help patients manage their care at home and prevent readmissions.

In conclusion, the operational aspects of LTACs, including admission and discharge processes and key performance metrics, are integral to the delivery of high-quality, cost-effective care. Continuous monitoring and improvement in these areas are essential for LTACs to fulfill their mission and meet the needs of patients with complex medical conditions.

Regulatory and Reimbursement: Navigating the Financial Landscape

To truly appreciate the unique role of Long-Term Acute Care (LTAC) facilities, it is essential to understand the regulatory and reimbursement environment in which they operate. This complex landscape significantly impacts their financial viability and, consequently, their ability to provide specialized care.

The Central Role of CMS

The Centers for Medicare & Medicaid Services (CMS) stands as the primary regulatory and reimbursement body for LTACs. CMS establishes the rules, guidelines, and payment structures that dictate how these facilities are reimbursed for the services they provide to Medicare and Medicaid beneficiaries.

CMS plays a pivotal role in defining patient eligibility criteria, setting quality standards, and monitoring LTAC performance. This oversight is crucial for ensuring that LTACs deliver appropriate and effective care while adhering to federal regulations.

Medicare Coverage Policies: A Detailed Look

Medicare coverage for LTAC services is governed by specific criteria outlined by CMS. These criteria include medical necessity, the complexity of the patient's condition, and the requirement for specialized care that cannot be adequately provided in other settings.

The 25% Rule and its Implications

One of the most significant policies impacting LTACs is the "25% Rule" (originally much higher, but reduced over time). This rule limits the percentage of a LTAC's patients that can be admitted from a single referring hospital. The goal is to prevent LTACs from becoming de facto extensions of acute care hospitals and to ensure a diverse patient mix.

The 25% rule has led to considerable debate, with some arguing it restricts patient access to necessary care. Others maintain it promotes competition and prevents inappropriate utilization of LTAC services.

Payment Structures: DRGs and Beyond

Medicare primarily reimburses LTACs through a Diagnosis-Related Group (DRG) prospective payment system. Under this system, LTACs receive a predetermined payment amount based on the patient's diagnosis and other factors.

This payment structure incentivizes efficiency and cost-effectiveness. However, it also requires LTACs to carefully manage resources and ensure that the quality of care is not compromised.

State-Specific Medicaid Coverage

While Medicare is the primary payer for most LTAC services, Medicaid also plays a role, particularly for eligible low-income individuals. Medicaid coverage for LTAC care varies significantly from state to state.

Each state sets its own eligibility criteria, covered services, and reimbursement rates. This variation can create complexities for LTACs operating in multiple states, as they must navigate different regulatory and financial landscapes.

State Oversight: Ensuring Quality and Compliance

In addition to federal regulations, LTACs are subject to state-level oversight by State Departments of Health or equivalent agencies. These agencies are responsible for licensing, inspecting, and monitoring LTAC facilities to ensure they meet state standards for patient safety, quality of care, and operational compliance.

State inspections and surveys can identify deficiencies and areas for improvement, prompting LTACs to implement corrective actions and enhance their practices. This dual layer of federal and state oversight helps to maintain accountability and protect patient interests.

Ethical and Legal Considerations: Patient Rights and End-of-Life Care

Regulatory and Reimbursement: Navigating the Financial Landscape To truly appreciate the unique role of Long-Term Acute Care (LTAC) facilities, it is essential to understand the regulatory and reimbursement environment in which they operate. This complex landscape significantly impacts their financial viability and, consequently, their ability to provide optimal patient care, especially concerning ethical and legal safeguards.

LTACs, entrusted with the care of individuals facing prolonged and critical illnesses, operate at the intersection of complex medical needs and profound ethical considerations. Protecting patient autonomy, ensuring informed consent, and honoring end-of-life wishes are not merely procedural formalities but fundamental pillars of compassionate and ethical care within these facilities.

Advance Directives and End-of-Life Care

Advance directives, such as living wills and durable powers of attorney for healthcare, are legal documents that allow individuals to express their preferences regarding medical treatment in the event they become unable to communicate their wishes. LTACs have a crucial role in ensuring these directives are respected and followed.

LTACs must have robust systems in place to identify, document, and readily access patients' advance directives. This includes incorporating advance directive information into the patient's medical record and making it easily accessible to all members of the care team.

The ethical obligation extends beyond merely acknowledging these documents. It demands a proactive approach to understanding the patient's values and beliefs, engaging in open and honest conversations with patients and their families, and translating those preferences into a comprehensive plan of care.

Patient Rights and Autonomy

The ethical foundation of LTAC care rests on the principle of patient autonomy: the right of individuals to make informed decisions about their medical treatment. This right is enshrined in law and upheld by healthcare ethics.

Protecting patient autonomy involves ensuring that patients have access to clear, understandable information about their medical condition, treatment options, and potential risks and benefits. It also means respecting their right to refuse treatment, even if that decision may have serious consequences.

LTACs must foster a culture of respect, dignity, and open communication.

This involves creating an environment where patients feel empowered to voice their concerns, ask questions, and participate actively in their care. It also requires ongoing education and training for staff on patient rights and ethical decision-making.

Informed Consent: A Cornerstone of Ethical Practice

Informed consent is more than just a signed form; it is an ongoing process of communication and shared decision-making between healthcare providers and patients. It ensures patients understand the nature of their condition, the proposed treatment, and potential alternatives, allowing them to make informed choices.

In the LTAC setting, where patients often face complex medical challenges and may have cognitive impairments, obtaining informed consent can be particularly challenging. It requires careful assessment of the patient's decision-making capacity and, when necessary, involving designated surrogates or legal guardians.

LTACs should utilize multidisciplinary teams to provide comprehensive information and support to patients and their families.

This includes physicians, nurses, social workers, and other healthcare professionals who can help patients navigate the complexities of their medical condition and make informed decisions that align with their values and goals.

LTACs must prioritize clear communication, patient education, and shared decision-making to uphold the ethical and legal principles that underpin the delivery of high-quality, patient-centered care.

Ethical and Legal Considerations: Patient Rights and End-of-Life Care Regulatory and Reimbursement: Navigating the Financial Landscape

To truly appreciate the unique role of Long-Term Acute Care (LTAC) facilities, it is essential to understand the regulatory and reimbursement environment in which they operate. This complex landscape significantly influences the structure of the industry and how LTACs are organized and managed.

Industry Landscape: Major LTAC Chains and Organizational Structure

The LTAC industry is comprised of a mix of large, for-profit chains, smaller regional operators, and non-profit entities. Understanding the major players and their organizational structures provides insight into the scale and scope of LTAC operations across the United States.

Key LTAC Chains: An Overview

Several major chains dominate the LTAC landscape, demonstrating a significant presence in multiple states. These companies often possess the resources and expertise to manage complex patient populations and navigate the challenging regulatory environment. Key players include, but are not limited to:

• Select Medical: One of the largest operators of LTAC hospitals, Select Medical boasts a vast network of facilities across the country. They offer a wide range of post-acute care services, including LTAC, rehabilitation, and outpatient care. Their extensive reach and integrated approach to care contribute to their prominent position in the industry.

• Kindred Healthcare: While Kindred Healthcare has undergone significant changes in recent years, they remain a notable entity in the post-acute care sector. Although no longer operating as a standalone LTAC company, the legacy of Kindred Healthcare and its impact on LTAC services are undeniable.

• Ernest Health: Ernest Health focuses exclusively on operating rehabilitation and long-term acute care hospitals. They aim to provide high-quality, individualized care. With facilities spread across multiple states, Ernest Health exemplifies a more regional approach to LTAC services, prioritizing specialized care within a focused geographic area.

Organizational Structure: A Typical LTAC Hospital

The organizational structure of a typical LTAC hospital is designed to support the delivery of specialized medical and rehabilitative care. While specific structures may vary based on the size and ownership of the facility, several core elements are consistently present.

• Executive Leadership: At the helm is the hospital's executive leadership team, typically led by a Chief Executive Officer (CEO) or Administrator. This team is responsible for the overall strategic direction, financial management, and operational efficiency of the hospital.

• Medical Staff: The medical staff comprises physicians, including pulmonologists, intensivists, and internal medicine specialists, who provide direct patient care and oversee treatment plans. The Medical Director plays a critical role in ensuring the quality of medical care and adherence to clinical standards.

• Nursing Department: The nursing department is the backbone of LTAC operations, providing 24/7 care and monitoring of patients. The Chief Nursing Officer (CNO) leads the nursing staff. The CNO is responsible for maintaining high standards of nursing practice.

• Rehabilitation Services: This department includes physical therapists, occupational therapists, and speech-language pathologists. They work collaboratively to develop and implement individualized rehabilitation plans to improve patients' functional abilities and independence.

• Ancillary Services: Ancillary services encompass a range of support functions. These include respiratory therapy, pharmacy, dietary services, case management, and social work. These services are crucial for addressing the holistic needs of patients and facilitating a smooth transition back to their prior living situation.

• Administrative Support: The administrative support team handles essential functions such as finance, human resources, billing, and regulatory compliance. They ensure the smooth operation of the hospital and adherence to all applicable laws and regulations.

Understanding the industry landscape and organizational structure of LTAC facilities is crucial for patients, providers, and policymakers alike. This knowledge facilitates informed decision-making and helps ensure that patients receive the specialized care they need in the most effective and efficient manner.

So, that's the gist of long term acute care meaning and how LTAC hospitals operate here in the US. Hopefully, this guide has shed some light on what can be a complex topic. If you or a loved one are facing a situation where long term acute care might be necessary, remember to consult with your doctor to determine the best course of action.