Many patients leaving the ICU may benefit from additional care before returning home. Long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs) are two settings that are often misunderstood as providing the same level of care. However, a closer look at available staff and services reveals a clear distinction in intensity and quality of care available at each location. 

This white paper explores the key differentiators between LTACHS and SNFs regarding clinical capabilities, patient populations and hospital outcomes. Based on these comparisons, LTACHs not only efficiently and effectively meet the needs of medically complex patients, but strategic partnership with LTACHs can reduce costs and improve hospital throughput.1

Setting Comparison: LTACHs and SNFs

Choosing the appropriate level of care for medically complex and critically ill patients leaving the ICU is essential for achieving optimal outcomes for both patients and providers. The below chart outlines the services and staff available at LTACHs and SNFs, revealing characteristics that allow LTACHs to provide a higher acuity of care for this growing patient population.



  • On-site physician visits at least once per day, sub-specialists available on location

  • On-site physician visits at least once every 30 days for the first 90 days, sub-specialists seen offsite

  • Approximately 1-6 patients per nurse, ratios lower in critical care units; High-acuity care provided by BLS- and ACLS-certified nurses with advanced critical care training

  • Approximately 10-40 patients per nurse

  • 24/7 respiratory therapy in house in every location

  • Limited respiratory therapy in select locations

  • Onsite services such as telemetry, radiology, pharmacy, lab, and dialysis

  • Radiology, pharmacy, lab, and dialysis services accessible, but not onsite

  • CMS-compliant infection control standards with hospital-level air ventilation systems and negative pressure isolation rooms

  • Residential-level air ventilation systems

The differences in available staff and resources between LTACHs and SNFs means that they are designed to treat different types and severities of conditions. 

Top Five Conditions by Setting: LTACHs and SNFs

Top Conditions Treated within each setting



  • Pulmonary edema and respiratory failure

  • COVID-19

  • Respiratory system diagnosis with ventilator for 96+ hours

  • Urinary tract infection, site

not specified

  • Septicema without ventilator support 96+ hours with major complication or comorbidity

  • Metabolic encephalopathy

  • Respiratory system diagnosis with ventilator support ≤96 hours

  • Sepsis, unspecified organism

  • Respiratory infections and inflammations with major complication or comorbidity

  • Encounter for other orthopedic aftercare

Aside from the differences in principle admitting condition, many of the top conditions treated at LTACHs include a major complication or comorbidity. The Hierarchical Condition Category (HCC) score, which assigns complexity levels to patients, was almost 2X higher at LTACHs than SNFs in 2021, indicating that more clinically complex patients with serious medical conditions continue to be admitted and treated with the LTACH setting.4 With physician-led acute care, LTACHs are able to treat patients with complex conditions, most of which include a pulmonary diagnosis. SNFs, on the other hand, care for a wide range of conditions that can be managed by nursing staff.   

Additionally, patients discharged to LTACHs after leaving an ICU or med-surg unit have a higher level on the Severity of Illness (SOI) Index than those discharged to SNFs. While only a small percentage discharged to a SNF present an “extreme” SOI, these patients make up over half the population transitioning to an LTACH.5  Regardless of overlap in treated conditions, LTACHs have unique expertise in addressing cases of greater severity.

Hospital Outcomes: LTACHs and SNFs

When critically ill patients, especially those with complex pulmonary conditions, receive the specialized acute care available at LTACHs, they are well positioned to fully recover faster. Even though patients at LTACHs tend to have more complex conditions, they experience both shorter lengths of stay (LOS) and fewer readmissions than those at SNFs.4 This is even more clear when looking at pulmonary diagnoses such as DRG 189, one of the most commonly treated at LTACHs.


ltach chartltach chart2Partnership has become a leading strategy to improve quality while still meeting the needs of the growing medically complex patient population. With the expertise and resources gained through partnership, your health system can deliver the physician-led treatment and rehabilitation needed to ensure critically ill patients receive the most appropriate level of care, while reducing length of stay and readmissions. 

How Partnership with Kindred Can Help

Each year, the Centers for Medicare & Medicaid Services (CMS), penalizes hospitals for excessive 30-day readmission rate. In 2018, over 2,500 hospitals were penalized, amounting to more than $564 million.6 Strategic partnership can help your hospital reduce readmissions, improve outcomes, and increase patient throughput. As an industry leader with a history of successful partnerships, Kindred Hospital offers hospital-in-hospital, contract management and joint-venture opportunities. Expand access to needed acute care services by integrating an LTACH into your health system’s care continuum today. 

Discover how your hospital can benefit from an LTACH partnership by visiting


By User Not Found