What Is a Long-Term Care Hospital (LTCH)? Long-Term Acute Care Explained
What long-term acute care hospitals do, who they serve, how Medicare treats them, and how they differ from nursing homes and rehab hospitals.
A long-term care hospital (LTCH, often called an LTAC) is a Medicare-certified hospital that treats patients with complicated medical conditions who need hospital-level care for an extended time. Families usually hear the term when a relative has been in an intensive care unit for a long period and is still too sick to go home or to a nursing home.
What Medicare says
CMS defines an LTCH under Medicare rules as a hospital whose Medicare patients have an average length of stay of more than 25 days. LTCHs are paid under their own prospective payment system. The CMS LTCH page describes the payment system and the criteria that determine which stays are paid at the higher rate. Those criteria generally look at whether the patient had a recent stay in an intensive care unit or needed extended mechanical ventilation, so check the current rules with the hospital and the plan.
Who goes to an LTCH
LTCH patients commonly include people who are being weaned from a ventilator, who have complex wounds or infections needing frequent medical management, or who have several serious conditions at once. These are patients who are still medically unstable enough that a nursing home is not equipped to care for them, but who no longer need the intensity of a short-term acute hospital. A physician usually visits daily and the hospital provides respiratory therapy, nursing and other services.
How an LTCH differs from other options
- Short-term acute hospital: treats the emergency or surgery; stays are short.
- LTCH: a hospital stay that continues for weeks for patients with complex needs.
- Inpatient rehabilitation facility (IRF): an intensive therapy program for patients who can take part in about three hours of therapy a day. See our IRF guide.
- Skilled nursing facility (SNF): skilled nursing and therapy with less medical complexity.
Choosing among options
The hospital's doctors and discharge planner will recommend a setting based on the patient's condition. You can ask why an LTCH rather than a skilled nursing facility, and what would make the patient eligible to move to a lower level of care. Ask what goals the LTCH team has for the patient and how they will measure progress. Ask what happens if the patient does not improve or if coverage ends.
Coverage and costs
Medicare Part A may cover LTCH care when the patient meets the requirements, and the patient pays the Part A deductible and coinsurance that apply. Medicare Advantage plans may require prior authorization and may use a network. Ask the LTCH's admissions staff to confirm coverage in writing before the transfer, and ask what you would owe. If you are told that coverage is ending, you can appeal; see Medicare's guide on appeals.
Questions to ask
- How many physicians cover the hospital, and how often will the patient be seen?
- What is the experience of the staff with this patient's condition, such as ventilator weaning?
- How are families updated, and can family visit freely?
- What is the plan for discharge, and where do most patients go next?
- Is the hospital in the patient's insurance network?
About this directory
The listings on this site come from the CMS Provider Data Catalog. They show the facility's Medicare certification number, ownership, bed count and certification date. They are not ratings, and a listing is not a recommendation. For quality information, use Medicare Care Compare.
Family role and decisions
Families of LTCH patients often face hard decisions about goals of care. Ask the physicians for a plain-language explanation of the patient's condition, what recovery realistically looks like and what the options are if progress is slow. Ask whether the hospital has a palliative care or ethics consultation service that can help the family talk through choices. If the patient has an advance directive or a health care proxy, bring a copy and make sure the care team has it. Keep a notebook of names, questions and answers; the care team changes over a long stay, and written notes help you keep track.
General information only, current as of the date above. The information on Inpatient Rehab & LTCH Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Rules and programs change; check the official sources linked in this guide.