Early LTACH Referral May Support Better Outcomes for Medically Complex ICU Patients
For care teams managing medically complex ICU patients, one of the most important questions is simple: What comes next?
While some patients are ready to transition to lower levels of care, others continue to require hospital-level treatment, prolonged mechanical ventilation, complex wound management, and ongoing rehabilitation.
Determining the most appropriate post-acute setting can have meaningful implications for recovery. Emerging evidence suggests that earlier evaluation for long-term acute care hospital (LTACH) services may influence outcomes such as ventilator liberation, readmission rates, and discharge disposition. For appropriate patients, timely LTACH referral may help ensure specialized care begins when it can have the greatest impact.
Timing May Affect Ventilator Liberation
For patients requiring prolonged mechanical ventilation, successful liberation from the ventilator is an important recovery milestone. The Centers for Medicare & Medicaid Services reports that 54.7% of patients admitted to LTACHs on invasive mechanical ventilation were successfully liberated during their LTACH stay, based on national data covering October 2024 through September 2025.²
Ventilator liberation rate for LTACH patients
Research also indicates that the timing of an LTACH transition may matter. A study of 13,622 patients requiring prolonged mechanical ventilation examined the relationship between time spent in a short-term acute care hospital (STACH) after intubation and later ventilator-weaning outcomes at an LTACH. Each additional day in the STACH after intubation was associated with an 11.6% reduction in the odds of successful ventilator weaning at the LTACH.³
Reduction in odds of LTACH weaning success for each additional day spent in the STACH after intubation
LTACHs Demonstrate Lower Readmission Rates
Selecting the appropriate post-acute setting is especially important for medically complex patients at increased risk of readmission. Data comparing 30-day readmission rates by Hierarchical Condition Category (HCC) tier show meaningful differences among similarly high-acuity populations.
For patients in the Very High HCC tier, the average 30-day readmission rate was 17% at LTACHs, compared with 42% at skilled nursing facilities (SNFs) and 39% at inpatient rehabilitation facilities (IRFs). Among patients in the High HCC tier, the rate was 12% at LTACHs, compared with 26% at SNFs and 28% at IRFs.¹ Overall, average readmission rates across these two tiers were approximately 50% lower at LTACHs than at SNFs and IRFs.¹
LTACH care may also support longer-term recovery goals. A comparative study found that LTACH patients were more likely to be discharged home and less likely to require discharge to an SNF than similar patients who remained in an acute care hospital.⁴
Identify Potential LTACH Patients Early
Within the first three to seven days of an ICU stay, the longer-term needs of many critically ill patients may become clearer. Once major diagnostic and surgical interventions are largely complete, potential indicators for an LTACH evaluation include:
- Prolonged mechanical ventilation or anticipated difficulty weaning
- An ICU stay of three days or longer with continued hospital-level needs
- Complex wounds, serious infections, or multisystem complications
- Multiple comorbidities requiring an extended recovery period
Early identification gives care teams more time to evaluate treatment options, initiate authorization requirements, and prepare for a coordinated transition.
At Kindred Hospitals, Clinical Liaisons collaborate with physicians, case managers, and other care team members to assess eligibility, navigate administrative requirements, and coordinate transfer when LTACH care is appropriate. Kindred’s physician-led interdisciplinary teams integrate nursing, respiratory therapy, rehabilitation, and other clinical disciplines. This allows rehabilitation to begin while patients continue receiving acute medical treatment, based on their condition and ability to participate.
For medically complex patients facing a prolonged recovery, starting the LTACH conversation earlier may help provide timely access to the specialized treatment and rehabilitation they need.
Have a Patient Who May Benefit From LTACH Care?
Connect with our Clinical Liaison team to discuss patient eligibility, care options and the referral process.
References
- The Advisory Board. The Post Acute Care Pathways Explorer: State Average Outcomes by HCC Score Tier. Accessed September 2025. Proprietary source; no publicly accessible link is available.
- Centers for Medicare & Medicaid Services. Long-Term Care Hospital – National Data. Ventilator Liberation Rate: 54.66%. Reporting period October 1, 2024–September 30, 2025.
- Demiralp B, Koenig L, Xu J, Soltoff S, Votto J. Time spent in prior hospital stay and outcomes for ventilator patients in long-term acute care hospitals. BMC Pulmonary Medicine. 2021;21:104.
- Votto JJ, Scalise PJ, Barton RW, Vogel CA. An analysis of clinical outcomes and costs of a long term acute care hospital. Journal of Medical Economics. 2011;14(2):141–146.