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Long-Term Care Hospitals

What are Long-Term Care Hospitals (LTCH)?  These facilities are different from nursing homes.  The New York Times explains the type of care they provide:

These are no ordinary hospitals: Critically ill patients, sometimes unresponsive or in comas, may live here for months, even years, sustained by respirators and feeding tubes. Some, especially those recovering from accidents, eventually will leave. Others will be here for the rest of their lives…

But more experts and policy makers are likely to have to start thinking about them soon. The cost of long-term acute care is substantial, about $26 billion a year in the United States, and by one estimate the number of patients in these facilities has more than tripled in the past decade to 380,000.

Doctors are getting better at keeping people alive. This is certainly a positive development. However, the expense to keep people alive on ventilators or other intensive devices is non-trivial. Although most patients in LTCH’s are initially covered by Medicare, the benefit runs out at 150 days. After this point, either private insurance or (more likely) Medicaid takes over or–in the worst case–the patient is unnecessarily discharged. Even those covered by Medicare are experiencing cuts.

Medicare, concerned about the high price of long-term acute care hospitals, is trying to trim reimbursements. Nearly half of the $7.3 billion cut from its budget by the Affordable Care Act came from reductions in payments to these facilities. Medicare officials argue that perhaps these patients could stay in regular hospitals or nursing homes instead, and say it’s unclear whether care is better in long-term acute care hospitals.

However, these dollar figures often hide the human aspect.

But while many of these patients may occupy a frightening middle ground between death and the lives they once knew, some do find happiness. The children, some abandoned by their parents, gurgle happily in the hands of volunteers careful not the disturb their respirator hoses. The couple who recently were married, Chris Plum, 38, and Margaret Lavigne, 43, share a room crowded with medical equipment, attended at all hours by determined aides. They kiss each other good night before being lifted into separate hospital beds.

Does hope spring eternal?

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