Differences Between Long-Term Acute Care Facilities and Nursing Homes
Are all care facilities the same? Families often confuse nursing homes with long-term acute care hospitals, but the differences in services, staffing, and oversight can be huge. Knowing the distinction can impact your loved one’s recovery and rights. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Melissa Pickett to break down the key differences between these care settings and what families need to consider when making care decisions.
Pickett:
Nursing homes don’t have the staff to put in that kind of time. Some of the patients I’ve had to change dressings and do different procedures on their wound care daily can take up to two hours. By the time you get into that room, you clean them or you do move everything and put it back up. So that’s a lot of time to be stuck in a room and not be able to leave.
Intro
Schenk:
Hey out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I’ll be your host for this episode. Although a nursing home appears. In the title of the show today, we are talking about LTACs or long-term acute care facilities, how the medical care is different in that type of facility versus your typical nursing home.
But we’re certainly not doing that alone. We have the fantastic Melissa Pickett on the show. To walk us through that process. As I mentioned, we’re talking about Long-Term Acute Care today, LTACs, but we’re not doing that alone. We have Melissa Pickett on the show. Melissa Pickett, founder of Peaceful Views Consulting, is a legal nurse consultant with over 14 years of nursing experience in oncology.
Cardiac care, critical care and infection control, known for her integrity, compassion, and professionalism. Melissa brings clinical expertise and clear insight to complex medical legal cases, a lifelong learner and proud mother of three. She’s dedicated to bridging the gap between medicine and law while helping attorneys navigate high stakes cases with clarity and confidence, and we’re so happy to have her on.
Melissa, welcome to the show.
Pickett:
Hi, Rob. How are you doing today?
Who is a typical LTAC patient, and how are they different from a nursing home resident?
Schenk:
Can’t complain. Rocking and rolling. So typically I like to try to start off the podcast interview with a softball question. And your softball question is basically, what is an L Tech?
Pickett:
Very good question. So a lot of people will confuse what an L Tech is because it is, it can be layered in, in, in many avenues, meaning some of the LTACs have very specialty services that they offer.
A simple definition of an LTAC is an acute term acute care facility. So meaning that a patient that has been in a hospital for a very wide range of high need issues, medical issues, and they’ve reached that limit where they can’t stay at the hospital anymore, but they’re definitely not ready to go to a nursing home to go home or anything like that.
A 2020 study explores disparities in geriatric care on the impact of preventive health measures in elderly populations.
So they need to go somewhere where they can still be very closely monitored and allow. Constant nursing supervision so that if things start to waiver again on their care or on their reaction to whatever their situation is, they’re able to be quickly intervened upon. So what I mean by that would be, say a person was in a motorcycle accident and so maybe they’ve healed enough and they’re not critical enough to stay in an ICU or even a step down unit at a hospital ’cause they’ve reached their max stays which is.
A lot of times determined, by insurance and things like that, that a long-term acute care becomes an important option because not only can they get everything they were receiving in those critical care areas, they will get additional services to help them heal and get more ready for discharge to go.
This earlier research outlines the importance of routine assessments on the impact of preventive health measures in elderly populations.
Schenk:
So essentially, I guess it boils down to how, what the acuity level is of that person. If they’re high acuity, but they need continuing care they’re going to discharge from a hospital and go to an LTAC rather than a rehab or a skilled nursing facility.
Pickett:
Correct. And again, depending on that acuity, there’s different levels of that. For different LTAC facilities. One facility that I used to work for, it was actually housed right in the hospital. So if you, for example, if the patient coded and we couldn’t keep the patient on the unit, it was really easy to get them to the ICU very quickly ’cause we can get ’em back just like they were on the floor of a different level of the hospital, but they were receiving the care from the LTAC, not from the hospital directly.
What types of treatments or interventions are commonly performed in an LTAC but not in a nursing home?
Schenk:
Other than the staffing or the physicians available, et cetera, what are the interventions or what are the, what is the care that’s provided at an LTAC that’s not provided at an nursing home?
Pickett:
Excellent. So a lot of patients will be on ventilators, so they’re still receiving, they’re sustaining support through their breathing with those devices.
And we’re still in the process of weaning them. They may not be very alert yet. That’s not uncommon for them to come and still be really out of. The environment is either sedated or just not able to truly arouse extensive wound care that needs to be done and monitored pretty regularly, not just typical easy things.
So wound vacs, and, really post-surgical complications, things like that. Also long, longer term or more frequent IV antibiotics that they may still need to require that a nursing home would not be able to perform. As well as just some sorts of levels of rehab that they’ll be getting, PT and OT on top of that. But typically, again, still being brittle in their recovery and needing those critical skills.
Learn more about COVID-19’s effect on elderly residents on the impact of preventive health measures in elderly populations.
Schenk:
When you say like aggressive wound care, is that, are we talking like burns or,
Pickett:
It definitely can be, yeah, it could be burns. It can be from surgery where they have wound vacs that need to be monitored really closely because again, that’s, in great contact with the organs and things that internally can cause some damage if they’re not monitored and applied appropriately.
It is usually a combination of things, but wound care is big, especially if that patient’s unable to go home where they might be able to set up home care and things like that. But it’s still a little bit more critical in a nursing home.
This MDPI article evaluates staff communication practices on the impact of preventive health measures in elderly populations.
Can you describe the difference in physician oversight between an LTAC and a nursing home?
Schenk:
The attending physician is in charge of the medical care that the resident receives, but they’re typically only responsible for showing up.
At minimum once a month for the first three months typically, and then basically once every 60 days they’re on out. That’s the minimum of the attending physician in a nursing home. How does that compare to the physician’s involvement in an L Tech?
Pickett:
That’s another huge critical change. Some of the facilities will have, a lot of them will have daily rounds.
So it’s just again, in the hospital where the nurses will go around and the charge nurse will go around and you have respiratory therapy all discussing what the status of the patient is. And again, with discharge in mind, because we wanna get them to a point where they’re ready to go and not have those surprises at the end.
So you’re gonna not just have the daily nursing supervision, but the doctors are usually on staff insight, able to address immediate concerns for at least part of the day.
Learn what factors may increase the risk of mistreatment by reading our blog on the common triggers of elder abuse.
Schenk:
I see. Way more involvement with the attending physician. More similar to a hospital than a skilled nursing facility.
Pickett:
Exactly.
How do patient acuity levels impact the type of facility someone is placed in—LTAC versus nursing home?
Schenk:
Okay, so we have a patient that’s at a hospital that’s in a grave condition, but as you mentioned, they can come out of the ICU. What are some of those borderline cases? Hey, this person should go to an L Tech. No. I want ’em to go to the nursing home. Like what are, what’s that kind of give and take about where they’re gonna go?
Pickett:
So some of that’s also, the age of the patient as well and the investment of what they want for their treatment, right? What their choices are for their next stages of life as well. But they can go both ways just to keep patients, but typically making that decision really falls on the insurance being able to provide support for the family, right?
Because it’s not a cheap option to have. So if it’s not something that’s covered. Can become a big decision for the family as well. And then finding a facility close enough so the family can still be a part of that. Sometimes in more areas that don’t have as many LTACs, so not as populated of an area.
That can become a huge barrier as well. ’cause then the patient maybe have to be shipped further away and then family can’t visit and that becomes very difficult for them as well.
If your loved one lives in the Suwanee area, get legal help by visiting our Suwanee nursing home abuse lawyer page.
What are some common misconceptions families have about the differences between LTACs and nursing homes?
Schenk:
Speaking of that, what are some of the common misconceptions that you find the public has about LTACs with respect to, their difference between the LTAC and a hospital or an LTAC and a skilled nursing facility?
Pickett:
I think it’s a lot, what we just talked about as well is, they don’t really understand because it’s not something people really wanna talk about, and it’s not something we really. Know about unless you either had someone that is involved in having this type of care, or you have a medical professional that can talk about you, these different things with you.
So I think the education in the hospital by those teams, with preparing. Families and patients for what is to come is a huge step in that so that they have the opportunity to investigate and, with all the tools that we have now online to look those things up, it’s important to take those options to at least get some general knowledge, so that you have questions to ask if insurance or payment is not an issue.
Families wondering about their rights after a tragedy can read our post on wrongful death claims involving bedsores in nursing homes.
Schenk:
Is there typically gonna be an instance in which you would say someone can, nah, don’t go to the LTAC, you can just go to the nursing home. Wouldn’t you? Wouldn’t it be the LTAC 10 times outta 10?
Pickett:
As long as they meet that criteria. Because we still would have criteria to meet, to have to utilize the beds.
There’s also the availability, right? Are we getting enough people out because they do tend to stay pretty full. So that there are some variables there, but what I’ve seen. For the most part, it’s a financial reason that they don’t come in or it’s a change of status where they just want something and it’s not gonna be under any kind of umbrella.
For families in Georgia, this blog explains where and how to report suspected nursing home abuse.
Because typically a stay is like up to about 30 to 45 days. So it’s what you’re looking at when you’re going there. Typically, obviously there’s cases that leave a little sooner, but when you’re expecting them they’re gonna have to stay for a minimum of 30, 30 days is what you’re looking at.
Schenk:
It typically or ever, is it the case that you have an individual that’s in an LTAC forever? Like they’re not gonna be discharged from the LTAC?
Pickett:
The only way I would see that happening is if it was more of a private pay and insurance would never allow you to be there forever. We either need to be doing metrics to get you to certain steps so that we can move you to a different type of facility, if that’s a nursing home or other, some other type of care facility that maybe you need.
But typically, no. There have been patients that I’ve seen there that are for months, but I wouldn’t say for years because there’s things that can happen too. Like I said, if the patient codes and needs to go back to the ICU, they could be coming back and forth quite a bit. They tend to stay.
Learn how nursing home residents are protected in Episode 9: Nursing Home Residents’ Bill of Rights.
But we do have to be showing right through our efforts that we’re making progress, and if not, we need to be having those conversations of why that’s not happening.
Schenk:
My understanding of the nursing zeitgeist is only through TikTok. Okay. And it seems to me that nursing homes, as a nurse, gets a bad rap.
Oh, I gotta, I’m a nurse and I’m working at a nursing home, but I’m waiting to get a job at some other place. Right in, in that same idea, like where’s the LTAC? I feel like the LTAC is almost like a, it’s got the stress of an ICU, but maybe the bummer of working at a nursing home. Does that make sense?
Pickett:
It does make sense and I. It’s not an easy place to work and it is not for the faint of heart. I will be honest with you. It was probably one of the most difficult but rewarding jobs I’ve ever had. And not only ’cause I was functioning a lot as a charge nurse or above in these roles, and so I not only had to help with patients, but also help with.
The staff, right? So I got to see a lot and how that affected them. And with having the patients there longer, like a nursing home, you do get attached to the families and the patients a little bit more because you’re spending a lot of time with them. And typically when you come on and off shift, you know they have their favorites and they want you back if they have bonded with you.
’cause they trust you and the patients trust you. And patients do better when they have caregivers that trust them. I think more, to answer your question, it’s probably looked at a little bit more respected because when people understand and see what a nurse is actually doing and managing, you are functioning at a pretty high level constantly.
Discover strategies to protect vulnerable residents in Episode 11: Safeguarding Nursing Home Residents – Common Risks.
And even with your supporting, your medical assistants and all of the staff around you, it has to be a strong team in order to keep those patients safe and getting things done, made, done every day. Because, yeah it’s sad because, and that’s one thing I’m passionate about right now is looking at how we change that perspective of a nursing home, right?
Because we have some wonderful people doing amazing work, and again, with limited resources and very difficult situations.
If you’re acting on behalf of a resident, check out Episode 13: Acting on Behalf of a Nursing Home Resident.
What kind of monitoring or medical equipment is available in LTACs that nursing homes typically do not have?
Schenk:
I didn’t ask you this, but in terms of medical equipment, is there anything that’s happening in the L Tech that absolutely does not happen in a nursing home?
Pickett:
Just about everything that can happen in an LTAC won’t be including patients that would get hemodialysis. ’cause that could happen at the bedside, depending on if they have, room set up for that. Which is very nice for the patient ’cause they’re not leaving that space. The dialysis nurses coming to them for forwarding that procedure.
Again, ventilators and things like that. If you’re weaning and actively trying to remove a patient from that, it’s going to be something that stays completely in LTAC. IV antibiotics that need to be administered daily. That’s very difficult for a nursing home to do. I wouldn’t say it never happens, but I think it’s pretty hard to get approved for happening because again, your nurse ratio is quite different there.
For families seeking help, Episode 150 shares five essential resources for Georgia nursing home residents.
And a nurse would have to be overseeing an LPN or administering them themselves. And even some of the extensive wound care, because not in nursing homes, don’t have the staff to put that kind of time. Some of the patients I’ve had to change dressings and do different procedures on their wound care daily can take up to two hours.
By the time you get into that room, you clean them or you do move everything and put it back up. So that’s a lot of time to be stuck in a room and not be able to leave. You have to have supporting staff to make sure all the patients are staying safe while you’re tucked away taking care of that.
Episode: What Does Acuity Mean for Nursing Home Care? explains why a resident’s care level matters for staffing and outcomes.
Schenk:
Well, Melissa very much appreciates you coming out on the show and sharing your knowledge with us.
Pickett:
Thank you for having me. It was great to be here.
Schenk:
Great folks, I hope you found this episode educational enlightening. If you have an idea for a topic that you would like for me to discuss, please let me know.
If you have an idea for a guest that you would like for me to talk to, please let me know that as well. Again, favorite salad dressing. Put your favorite salad dressing, enter to win the coffee mug. It’s a good looking coffee mug. It’s got a little symbol on there. Podcast. It’s pretty good stuff. New episodes of the Nursing Home piece Podcast come out every single Monday.
And with that folks. We’ll see you next time.
Melissa Pickett’s Contact Information: